Incidence of hepatocellular carcinoma in Italy: what could we learn from autoptic studies?

From January 1, 1968 to December 31, 1984, 31,955 autopsies were performed at the Department of Pathology of the University of Trieste. Of these 16,521 were male and 15,434 female which covered about 70% of the population who died in the area over the recent years. Hepatocellular carcinoma (HCC) associated with liver cirrhosis was encountered in 441 cases (380 males and 61 females, M:F ratio 5.8:1) with an overall occurrence of 1.4% in the autoptic population. On the contrary and in the absence of chronic liver disease HCC was only observed in 0.3% of the cases (45 males and 16 females, M:F ratio 2.7:1). Liver cirrhosis accounted for 10% of autopsies (2099 males and 1104 females, M:F ratio 1.8:1). A 15% of cirrhosis was associated with HCC, indicating that major attention should be paid to cirrhotic patients, in particular males after the 5th decade of life. The year distribution of HCC and cirrhosis was fairly constant during the period of time considered. These data suggest that: i) HCC is common in Italy; ii) in the vast majority, HCC occurs in the presence of cirrhosis; and iii) HCC appears to be a rather late disease as it does not reduce the life expectancy of cirrhotic and control populations. Since reliable, nationwide epidemiological data are not available in Italy, it is not known whether these data represent a local realty or whether they may be extrapolated to the entire country. Cooperative and prospective studies appear appropriate in investigating possible geographical differences in HCC distribution and permit a better understanding and prevention of the disease.