Original Contribution
The American Journal of Gastroenterology (2007) 102, 1022–1031; doi:10.1111/j.1572-0241.2007.01100.x
Impact of Etiology of Cirrhosis on the Survival of Patients Diagnosed With Hepatocellular Carcinoma During Surveillance
CME
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Franco Trevisani MD1, Giulia Magini MD1, Valentina Santi MD1, Antonio Maria Morselli-Labate PhD2, Maria Chiara Cantarini MD1, Maria Anna Di Nolfo MD3, Paolo Del Poggio MD4, Luisa Benvegnù MD5, Gianludovico Rapaccini MD6, Fabio Farinati MD7, Marco Zoli MD1, Franco Borzio MD8, Edoardo Giovanni Giannini MD9, Eugenio Caturelli MD10 and Mauro Bernardi MD1 for the Italian Liver Cancer (ITA.LI.CA) Group
- 1Dipartimento di Medicina Interna, Cardioangiologia, Epatologia
- 2Dipartimento di Medicina Interna e Gastroenterologia, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
- 3Divisione di Medicina, Ospedale Bolognini, Seriate, Italy
- 4Divisione di Medicina, Ospedale Treviglio-Caravaggio, Treviglio, Italy
- 5Dipartimento di Medicina Clinica e Sperimentale, Università di Padova, Italy
- 6Cattedra di Medicina Interna II, Università Cattolica di Roma, Italy
- 7Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università di Padova, Italy
- 8Dipartimento di Medicina, Unità di Gastroenterologia, Ospedale Fatebenefratelli, Milano, Italy
- 9Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Università di Genova, Italy
- 10Unità di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy
Correspondence: Franco Trevisani, MD, Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Semeiotica Medica, via Albertoni, 15, 40138 Bologna, Italy.
Received 30 September 2006; Accepted 28 November 2006.
Abstract
OBJECTIVES:
Although the etiology of liver disease affects the features of hepatocellular carcinoma (HCC) diagnosed during surveillance, it is not known whether it influences patients' survival. We analyzed the impact of etiology on the characteristics and outcome of HCC detected during surveillance.
METHODS:
In this cohort study, 742 patients with HCC detected during semiannual or annual surveillance were selected from the ITA.LI.CA database, including 1,834 consecutive patients observed in three primary and seven tertiary care settings for HCC. Patients were grouped according to etiology: hepatitis B virus (HBV, 87), hepatitis C virus (HCV, 461), alcohol (59), and multietiology (135).
RESULTS:
In all etiologic groups, most HCCs were unifocal (51–68%) and most of them were 
3 cm (60–69%). Unifocal HCCs were less common in the multietiology group (P = 0.050) and slightly more frequent in the HCV group (P = 0.087). Besides etiology, only age was associated with gross pathology (P = 0.023). About two-thirds of HCCs in all groups were discovered at Cancer of the Liver Italyn Program (CLIP) stage 0 or 1.
The 1-, 3-, and 5-yr survival rates were comparable among groups (HBV 81%, 47%, and 22%; HCV 86%, 49%, and 24%; alcohol 76%, 41%, and 25%; multietiology 75%, 37%, and 24%; P = 0.446). The surveillance interval did not influence survival, which was independently predicted by serum 
-fetoprotein, Child-Pugh class, gross pathology, cancer size, vascular invasion, and treatment.
CONCLUSION:
In patients with HCC diagnosed during surveillance: (a) single nodules are less common in multietiology cases and (b) prognosis is independent of etiology, being dictated by liver function, oncologic features, and treatment.
