Etiologic factors and clinical presentation of hepatocellular carcinoma

Differences between cirrhotic and noncirrhotic Italian patients

F. Trevisani, P. E. D'Intino, P. Caraceni, M. Pizzo, G. F. Stefanini, A. Mazziotti, G. L. Grazi, G. Gozzetti, G. Gasbarrini, M. Bernardi

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

Background. It is not known whether the prevalence of hepatocarcinogenic factors differs between cirrhotic and noncirrhotic patients with hepatocellular carcinoma (HCC) or whether the clinical presentation of HCC in these two groups differs. Methods. The prevalence of the putative etiologic factors of HCC and its clinical presentation in 373 patients with cirrhosis and 102 without cirrhosis seen from 1981 to 1992 were evaluated. Results. Hepatitis C virus infection (76 vs. 48%, P = 0.003) and both current (22.5 vs. 10%, P = 0.007) and past (50.5 vs. 34.5%, P = 0.045) hepatitis B virus infections were more common in cirrhotic than in noncirrhotic patients with HCC. The absence of exposure to both viruses was much less frequent in the former (7 vs. 40%, P <0.001). Heavy alcohol intake prevailed in patients with cirrhosis (30 vs. 16.5%, P = 0.01). Alpha-fetoprotein elevation was more common in cirrhotic patients (63% vs. 31%, P <0.001); however, the prevalence of diagnostic (>400 ng/ml) levels did not differ significantly (24 vs. 17%) between the two groups. Extrahepatic extension of HCC was more common in noncirrhotic patients (20.5 vs. 6.5%, P <0.001) and its independent predictors were poor cancer differentiation and absence of cirrhosis. 'Asymptomatic' cancers were more frequently encountered with cirrhosis. Abdominal pain was the most common presenting symptom in both groups. Signs of hepatic decompensation prevailed in cirrhotic patients, whereas a 'toxic syndrome' dominated the clinical picture of the noncirrhotic patients. Conclusions. Hepatitis viruses are associated more with carcinogenesis of the cirrhotic than of the noncirrhotic liver. Alpha- fetoprotein is not a sensitive neoplastic marker, particularly in noncirrhotic patients. In the latter, HCC appears more advanced at diagnosis and symptoms of neoplastic toxicity are prominent.

Original languageEnglish
Pages (from-to)2220-2232
Number of pages13
JournalCancer
Volume75
Issue number9
Publication statusPublished - 1995

Fingerprint

Hepatocellular Carcinoma
Fibrosis
Virus Diseases
Hepatitis Viruses
Poisons
Liver
alpha-Fetoproteins
Hepatitis B virus
Hepacivirus
Abdominal Pain
Neoplasms
Carcinogenesis
Viruses

Keywords

  • alcohol
  • alpha-fetoprotein
  • cirrhosis
  • clinical presentation
  • hepatitis viruses
  • hepatocellular carcinoma
  • tobacco

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Trevisani, F., D'Intino, P. E., Caraceni, P., Pizzo, M., Stefanini, G. F., Mazziotti, A., ... Bernardi, M. (1995). Etiologic factors and clinical presentation of hepatocellular carcinoma: Differences between cirrhotic and noncirrhotic Italian patients. Cancer, 75(9), 2220-2232.

Etiologic factors and clinical presentation of hepatocellular carcinoma : Differences between cirrhotic and noncirrhotic Italian patients. / Trevisani, F.; D'Intino, P. E.; Caraceni, P.; Pizzo, M.; Stefanini, G. F.; Mazziotti, A.; Grazi, G. L.; Gozzetti, G.; Gasbarrini, G.; Bernardi, M.

In: Cancer, Vol. 75, No. 9, 1995, p. 2220-2232.

Research output: Contribution to journalArticle

Trevisani, F, D'Intino, PE, Caraceni, P, Pizzo, M, Stefanini, GF, Mazziotti, A, Grazi, GL, Gozzetti, G, Gasbarrini, G & Bernardi, M 1995, 'Etiologic factors and clinical presentation of hepatocellular carcinoma: Differences between cirrhotic and noncirrhotic Italian patients', Cancer, vol. 75, no. 9, pp. 2220-2232.
Trevisani F, D'Intino PE, Caraceni P, Pizzo M, Stefanini GF, Mazziotti A et al. Etiologic factors and clinical presentation of hepatocellular carcinoma: Differences between cirrhotic and noncirrhotic Italian patients. Cancer. 1995;75(9):2220-2232.
Trevisani, F. ; D'Intino, P. E. ; Caraceni, P. ; Pizzo, M. ; Stefanini, G. F. ; Mazziotti, A. ; Grazi, G. L. ; Gozzetti, G. ; Gasbarrini, G. ; Bernardi, M. / Etiologic factors and clinical presentation of hepatocellular carcinoma : Differences between cirrhotic and noncirrhotic Italian patients. In: Cancer. 1995 ; Vol. 75, No. 9. pp. 2220-2232.
@article{3b59f10ffa204c82896fb7a8642192a9,
title = "Etiologic factors and clinical presentation of hepatocellular carcinoma: Differences between cirrhotic and noncirrhotic Italian patients",
abstract = "Background. It is not known whether the prevalence of hepatocarcinogenic factors differs between cirrhotic and noncirrhotic patients with hepatocellular carcinoma (HCC) or whether the clinical presentation of HCC in these two groups differs. Methods. The prevalence of the putative etiologic factors of HCC and its clinical presentation in 373 patients with cirrhosis and 102 without cirrhosis seen from 1981 to 1992 were evaluated. Results. Hepatitis C virus infection (76 vs. 48{\%}, P = 0.003) and both current (22.5 vs. 10{\%}, P = 0.007) and past (50.5 vs. 34.5{\%}, P = 0.045) hepatitis B virus infections were more common in cirrhotic than in noncirrhotic patients with HCC. The absence of exposure to both viruses was much less frequent in the former (7 vs. 40{\%}, P <0.001). Heavy alcohol intake prevailed in patients with cirrhosis (30 vs. 16.5{\%}, P = 0.01). Alpha-fetoprotein elevation was more common in cirrhotic patients (63{\%} vs. 31{\%}, P <0.001); however, the prevalence of diagnostic (>400 ng/ml) levels did not differ significantly (24 vs. 17{\%}) between the two groups. Extrahepatic extension of HCC was more common in noncirrhotic patients (20.5 vs. 6.5{\%}, P <0.001) and its independent predictors were poor cancer differentiation and absence of cirrhosis. 'Asymptomatic' cancers were more frequently encountered with cirrhosis. Abdominal pain was the most common presenting symptom in both groups. Signs of hepatic decompensation prevailed in cirrhotic patients, whereas a 'toxic syndrome' dominated the clinical picture of the noncirrhotic patients. Conclusions. Hepatitis viruses are associated more with carcinogenesis of the cirrhotic than of the noncirrhotic liver. Alpha- fetoprotein is not a sensitive neoplastic marker, particularly in noncirrhotic patients. In the latter, HCC appears more advanced at diagnosis and symptoms of neoplastic toxicity are prominent.",
keywords = "alcohol, alpha-fetoprotein, cirrhosis, clinical presentation, hepatitis viruses, hepatocellular carcinoma, tobacco",
author = "F. Trevisani and D'Intino, {P. E.} and P. Caraceni and M. Pizzo and Stefanini, {G. F.} and A. Mazziotti and Grazi, {G. L.} and G. Gozzetti and G. Gasbarrini and M. Bernardi",
year = "1995",
language = "English",
volume = "75",
pages = "2220--2232",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "9",

}

TY - JOUR

T1 - Etiologic factors and clinical presentation of hepatocellular carcinoma

T2 - Differences between cirrhotic and noncirrhotic Italian patients

AU - Trevisani, F.

AU - D'Intino, P. E.

AU - Caraceni, P.

AU - Pizzo, M.

AU - Stefanini, G. F.

AU - Mazziotti, A.

AU - Grazi, G. L.

AU - Gozzetti, G.

AU - Gasbarrini, G.

AU - Bernardi, M.

PY - 1995

Y1 - 1995

N2 - Background. It is not known whether the prevalence of hepatocarcinogenic factors differs between cirrhotic and noncirrhotic patients with hepatocellular carcinoma (HCC) or whether the clinical presentation of HCC in these two groups differs. Methods. The prevalence of the putative etiologic factors of HCC and its clinical presentation in 373 patients with cirrhosis and 102 without cirrhosis seen from 1981 to 1992 were evaluated. Results. Hepatitis C virus infection (76 vs. 48%, P = 0.003) and both current (22.5 vs. 10%, P = 0.007) and past (50.5 vs. 34.5%, P = 0.045) hepatitis B virus infections were more common in cirrhotic than in noncirrhotic patients with HCC. The absence of exposure to both viruses was much less frequent in the former (7 vs. 40%, P <0.001). Heavy alcohol intake prevailed in patients with cirrhosis (30 vs. 16.5%, P = 0.01). Alpha-fetoprotein elevation was more common in cirrhotic patients (63% vs. 31%, P <0.001); however, the prevalence of diagnostic (>400 ng/ml) levels did not differ significantly (24 vs. 17%) between the two groups. Extrahepatic extension of HCC was more common in noncirrhotic patients (20.5 vs. 6.5%, P <0.001) and its independent predictors were poor cancer differentiation and absence of cirrhosis. 'Asymptomatic' cancers were more frequently encountered with cirrhosis. Abdominal pain was the most common presenting symptom in both groups. Signs of hepatic decompensation prevailed in cirrhotic patients, whereas a 'toxic syndrome' dominated the clinical picture of the noncirrhotic patients. Conclusions. Hepatitis viruses are associated more with carcinogenesis of the cirrhotic than of the noncirrhotic liver. Alpha- fetoprotein is not a sensitive neoplastic marker, particularly in noncirrhotic patients. In the latter, HCC appears more advanced at diagnosis and symptoms of neoplastic toxicity are prominent.

AB - Background. It is not known whether the prevalence of hepatocarcinogenic factors differs between cirrhotic and noncirrhotic patients with hepatocellular carcinoma (HCC) or whether the clinical presentation of HCC in these two groups differs. Methods. The prevalence of the putative etiologic factors of HCC and its clinical presentation in 373 patients with cirrhosis and 102 without cirrhosis seen from 1981 to 1992 were evaluated. Results. Hepatitis C virus infection (76 vs. 48%, P = 0.003) and both current (22.5 vs. 10%, P = 0.007) and past (50.5 vs. 34.5%, P = 0.045) hepatitis B virus infections were more common in cirrhotic than in noncirrhotic patients with HCC. The absence of exposure to both viruses was much less frequent in the former (7 vs. 40%, P <0.001). Heavy alcohol intake prevailed in patients with cirrhosis (30 vs. 16.5%, P = 0.01). Alpha-fetoprotein elevation was more common in cirrhotic patients (63% vs. 31%, P <0.001); however, the prevalence of diagnostic (>400 ng/ml) levels did not differ significantly (24 vs. 17%) between the two groups. Extrahepatic extension of HCC was more common in noncirrhotic patients (20.5 vs. 6.5%, P <0.001) and its independent predictors were poor cancer differentiation and absence of cirrhosis. 'Asymptomatic' cancers were more frequently encountered with cirrhosis. Abdominal pain was the most common presenting symptom in both groups. Signs of hepatic decompensation prevailed in cirrhotic patients, whereas a 'toxic syndrome' dominated the clinical picture of the noncirrhotic patients. Conclusions. Hepatitis viruses are associated more with carcinogenesis of the cirrhotic than of the noncirrhotic liver. Alpha- fetoprotein is not a sensitive neoplastic marker, particularly in noncirrhotic patients. In the latter, HCC appears more advanced at diagnosis and symptoms of neoplastic toxicity are prominent.

KW - alcohol

KW - alpha-fetoprotein

KW - cirrhosis

KW - clinical presentation

KW - hepatitis viruses

KW - hepatocellular carcinoma

KW - tobacco

UR - http://www.scopus.com/inward/record.url?scp=0028899830&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028899830&partnerID=8YFLogxK

M3 - Article

VL - 75

SP - 2220

EP - 2232

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 9

ER -