Bracco Christian, Gallarate Marta, Badinella Martini Marco, Magnino Corrado, D'Agnano Salvatore, Canta Roberta, Racca Giulia, Melchio Remo, Serraino Cristina, Polla Mattiot Valentina, Gollè Giovanni, Fenoglio Luigi
Department of Internal Medicine, Santa Croce e Carle General Hospital, Cuneo 12100, Italy.
Department of Medical Sciences, "City of Health and Science" University Hospital, Torino 10100, Italy.
World J Gastrointest Oncol. 2024 Mar 15;16(3):761-772. doi: 10.4251/wjgo.v16.i3.761.
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and the second leading cause of cancer deaths worldwide. It is often diagnosed at an advanced stage and therefore its prognosis remains poor with a low 5-year survival rate. HCC patients have increasingly complex and constantly changing characteristics, thus up-to-date and comprehensive data are fundamental.
To analyze the epidemiology and main clinical characteristics of HCC patients in a referral center hospital in the northwest of Italy between 2010 and 2019.
In this retrospective study, we analyzed the clinical data of all consecutive patients with a new diagnosis of HCC recorded at "Santa Croce e Carle" Hospital in Cuneo (Italy) between 1 January 2010 and 31 December 2019. To highlight possible changes in HCC patterns over the 10-year period, we split the population into two 5-year groups, according to the diagnosis period (2010-2014 and 2015-2019).
Of the 328 HCC patients who were included (M/F 255/73; mean age 68.9 ± 11.3 years), 154 in the first period, and 174 in the second. Hepatitis C virus infection was the most common HCC risk factor (41%, 135 patients). The alcoholic etiology rate was 18%, the hepatitis B virus infection etiology was 5%, and the non-viral/non-alcoholic etiology rate was 22%. The Child-Pugh score distribution of the patients was: class A 75%, class B 21% and class C 4%. The average Mayo end-stage liver disease score was 10.6 ± 3.7. A total of 55 patients (17%) were affected by portal vein thrombosis and 158 (48%) by portal hypertension. The average nodule size of the HCC was 4.6 ± 3.1 cm. A total of 204 patients (63%) had more than one nodule < 3, and 92% (305 patients) had a non-metastatic stage of the disease. The Barcelona Clinic Liver Cancer (BCLC) staging distribution of all patients was: 4% very early, 32% early, 23% intermediate, 34% advanced, and 7% terminal. Average survival rate was 1.6 ± 0.3 years. Only 20% of the patients underwent treatment. Age, presence of ascites, BCLC stage and therapy were predictors of a better prognosis ( < 0.01). A comparison of the two 5-year groups revealed a statistically significant difference only in global etiology ( < 0.05) and alpha-fetoprotein (AFP) levels ( < 0.01).
In this study analyzing patients with a new diagnosis of HCC between 2010-2019, hepatitis C virus infection was the most common etiology. Most patients presented with an advanced stage disease and a poor prognosis. When comparing the two 5-year groups, we observed a statistically significant difference only in global etiology ( < 0.05) and AFP levels ( < 0.01).
肝细胞癌（HCC）是最常见的原发性肝脏恶性肿瘤，也是全球癌症死亡的第二大主要原因。它通常在晚期被诊断出来，因此其预后仍然很差，5年生存率很低。HCC患者的特征日益复杂且不断变化，因此最新且全面的数据至关重要。
分析2010年至2019年意大利西北部一家转诊中心医院HCC患者的流行病学及主要临床特征。
在这项回顾性研究中，我们分析了2010年1月1日至2019年12月31日期间在意大利库内奥的“圣十字与卡尔莱”医院记录的所有新诊断为HCC的连续患者的临床数据。为突出10年间HCC模式可能的变化，我们根据诊断时间（2010 - 2014年和2015 - 2019年）将人群分为两个5年组。
纳入的328例HCC患者中（男/女255/73；平均年龄68.9±11.3岁），第一期有154例，第二期有174例。丙型肝炎病毒感染是最常见的HCC危险因素（41%，135例患者）。酒精性病因率为18%，乙型肝炎病毒感染病因率为5%，非病毒/非酒精性病因率为22%。患者的Child - Pugh评分分布为：A类75%，B类21%，C类4%。梅奥终末期肝病平均评分为10.6±3.7。共有55例患者（17%）受门静脉血栓形成影响，158例（48%）受门静脉高压影响。HCC的平均结节大小为4.6±3.1厘米。共有204例患者（63%）有多个<3厘米的结节，92%（305例患者）处于疾病的非转移阶段。所有患者的巴塞罗那临床肝癌（BCLC）分期分布为：极早期4%，早期32%，中期23%，晚期34%，终末期7%。平均生存率为1.6±0.3年。仅20%的患者接受了治疗。年龄、腹水的存在、BCLC分期和治疗是预后较好的预测因素（<0.01）。两个5年组的比较仅显示全球病因（<0.05）和甲胎蛋白（AFP）水平（<0.01）存在统计学显著差异。
在这项分析2010 - 2019年新诊断为HCC患者的研究中，丙型肝炎病毒感染是最常见的病因。大多数患者表现为晚期疾病且预后较差。比较两个5年组时，我们仅观察到全球病因（<0.05）和AFP水平（<0.01）存在统计学显著差异。
