Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2024; 16(3): 761-772
Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.761
Epidemiology, therapy and outcome of hepatocellular carcinoma between 2010 and 2019 in Piedmont, Italy
Christian Bracco, Marta Gallarate, Marco Badinella Martini, Corrado Magnino, Salvatore D'Agnano, Roberta Canta, Giulia Racca, Remo Melchio, Cristina Serraino, Valentina Polla Mattiot, Giovanni Gollè, Luigi Fenoglio
Christian Bracco, Marco Badinella Martini, Corrado Magnino, Salvatore D'Agnano, Roberta Canta, Giulia Racca, Remo Melchio, Cristina Serraino, Valentina Polla Mattiot, Giovanni Gollè, Luigi Fenoglio, Department of Internal Medicine, Santa Croce e Carle General Hospital, Cuneo 12100, Italy
Marta Gallarate, Department of Medical Sciences, "City of Health and Science" University Hospital, Torino 10100, Italy
Author contributions: Bracco C, Gallarate M and Fenoglio ML conceived and designed the research study; D’Agnano S, Canta R and Ruocco I performed the data collection; Magnino C, Casazza G, Racca G and Melchio R analyzed and interpreted the data; Bracco C, Gallarate M and Badinella Martini M wrote and edited the manuscript; All authors read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of “Santa Croce e Carle” General Hospital of Cuneo and the Cuneo 1 Local Health Authority.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have any potential conflicts of interest to disclose.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salvatore D'Agnano, MD, Doctor, Department of Internal Medicine, Santa Croce e Carle General Hospital, Via Michele Coppino 26, Cuneo 12100, Italy. dagnano.s@ospedale.cuneo.it
Received: October 19, 2023
Peer-review started: October 19, 2023
First decision: December 4, 2023
Revised: December 19, 2023
Accepted: December 28, 2023
Article in press: December 28, 2023
Published online: March 15, 2024
Processing time: 144 Days and 21.7 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

HCC patients have increasingly complex and constantly changing characteristics, thus up-to-date and comprehensive data are fundamental.

Research objectives

To analyze the epidemiology and main clinical characteristics of HCC patients in a referral hospital in the northwest of Italy between 2010 and 2019.

Research methods

In this retrospective study, we analyzed the clinical data of all consecutive patients with a new diagnosis of HCC recorded at the "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).

Research results

A total of 328 HCC patients 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 model for 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 non-metastatic stage of 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. The 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 (P < 0.01). A comparison of the two 5-year groups revealed a statistically significant difference only in global etiology (P < 0.05) and alpha-fetoprotein (AFP) levels (P < 0.01).

Research conclusions

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 poor prognosis. When comparing the two 5-year groups, we observed a statistically significant difference only in global etiology (P < 0.05) and AFP levels (P < 0.01).

Research perspectives

HCC remains undertreated or inappropriately treated despite the positive advances in diagnosis and treatment in recent years. We hope these findings will be a stimulus for the improved surveillance of patients at risk according to the guidelines of scientific societies, with the subsequent better use of the various therapies available.