Semeiotics Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
Liver Int. 2021 Mar;41(3):585-597. doi: 10.1111/liv.14735. Epub 2020 Dec 2.
Epidemiology of hepatocellular carcinoma (HCC) is changing in most areas of the world. This study aimed at updating the changing scenario of aetiology, clinical presentation, management and prognosis of HCC in Italy during the last 15 years.
Retrospective analysis of the Italian Liver Cancer (ITA.LI.CA) database included 6034 HCC patients managed in 23 centres from 2004 to 2018. Patients were divided into three groups according to the date of cancer diagnosis (2004-2008, 2009-2013 and 2014-2018).
The main results were: (i) a progressive patient ageing; (ii) a progressive increase of non-viral cases and, particularly, of 'metabolic' and 'metabolic + alcohol' HCCs; (iii) a slightly decline of cases diagnosed under surveillance, but with an incremental use of the semiannual schedule; (iv) a favourable cancer stage migration; (v) an increased use of radiofrequency ablation to the detriment of percutaneous ethanol injection; (vi) improved outcomes of ablative and transarterial treatments; (vii) an improved overall survival (adjusted for the lead time in surveyed patients) in the last calendar period, particularly in viral patients; (viii) a large gap between the number of potential candidates (according to oncologic criteria and age) to liver transplant and that of transplanted patients.
During the last 15 years several aspects of HCC scenario have changed, as well as its management. The improvement in patient survival observed in the last period was likely because of a larger use of thermal ablation with respect to the less effective alcohol injection and to an improved management of intermediate stage patients.
在世界大多数地区，肝细胞癌（HCC）的流行病学正在发生变化。本研究旨在更新意大利近 15 年来 HCC 的病因、临床表现、治疗和预后的变化情况。
回顾性分析了意大利肝癌（ITA.LI.CA）数据库中 2004 年至 2018 年期间在 23 个中心治疗的 6034 例 HCC 患者的数据。根据癌症诊断日期（2004-2008 年、2009-2013 年和 2014-2018 年）将患者分为三组。
主要结果如下：（i）患者年龄逐渐增大；（ii）非病毒性病例逐渐增多，特别是“代谢性”和“代谢性+酒精性”HCC；（iii）监测下诊断病例略有下降，但半年一次的监测方案使用逐渐增加；（iv）肿瘤分期向更有利的方向转移；（v）射频消融的应用增加，而经皮乙醇注射的应用减少；（vi）消融和经动脉治疗的效果得到改善；（vii）在最后一个时间段，尤其是在病毒性患者中，总生存率（调整监测患者的领先时间）得到提高；（viii）符合肿瘤学标准和年龄的潜在肝移植候选者数量与移植患者数量之间存在巨大差距。
在过去的 15 年中，HCC 的发生情况及其治疗方法发生了许多变化。最后一个时期观察到的患者生存率的提高可能是由于热消融的应用增加，而经皮乙醇注射的效果较差，以及中期患者的治疗管理得到改善。
