Landscape of alcohol-related hepatocellular carcinoma in the last 15 years highlights the need to expand surveillance programs
Background & Aims: Alcohol abuse and metabolic disorders are leading causes of hepatocellular carcinoma (HCC) worldwide. Alcohol-related aetiology is associated with a worse prognosis compared with viral agents, because of the lower percentage of patients diagnosed with HCC under routine sur...
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-08-01
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| Series: | JHEP Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589555923001155 |
| _version_ | 1797774495310675968 |
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| author | Nicola Reggidori Laura Bucci Valentina Santi Benedetta Stefanini Lorenzo Lani Davide Rampoldi Giorgia Ghittoni Fabio Farinati Alberto Masotto Bernardo Stefanini Andrea Mega Elisabetta Biasini Francesco Giuseppe Foschi Gianluca Svegliati-Baroni Angelo Sangiovanni Claudia Campani Giovanni Raimondo Gianpaolo Vidili Antonio Gasbarrini Ciro Celsa Mariella Di Marco Edoardo G. Giannini Rodolfo Sacco Maurizia Rossana Brunetto Francesco Azzaroli Donatella Magalotti Filomena Morisco Gian Ludovico Rapaccini Gerardo Nardone Alessandro Vitale Franco Trevisani Maurizio Biselli Paolo Caraceni Annagiulia Gramenzi Francesca Benevento Alessandro Granito Luca Muratori Fabio Piscaglia Francesco Tovoli Gloria Allegrini Calogero Cammà Giuseppe Cabibbo Carmelo Marco Giacchetto Paolo Giuffrida Maria Vittoria Grassini Mauro Grova Gabriele Rancatore Caterina Stornello Valentina Adotti Tancredi Li Cavoli Fabio Marra Martina Rosi Vittoria Bevilacqua Alberto Borghi Lucia Napoli Fabio Conti G.L. Frassineti Maria Teresa Migliano Gloria Allegrini Nicoletta de Matthaeis Francesca Romana Ponziani Gabriele Missale Andrea Olivani Mario Capasso Valentina Cossiga Maria Guarino Ester Marina Cela Antonio Facciorusso Camilla Graziosi Valentina Lauria Giorgio Pelecca Marta Schirripa Fabrizio Chegai Armando Raso Alessio Bozzi Maria Stella Franzè Carlo Saitta Assunta Sauchella Elton Dajti Federico Ravaioli Maria Corina Plaz Torres Giulia Pieri Filippo Oliveri Gabriele Ricco Veronica Romagnoli Alessandro Inno Fabiana Marchetti Pietro Coccoli Antonio Malerba Alberta Cappelli Rita Golfieri Cristina Mosconi Matteo Renzulli |
| author_facet | Nicola Reggidori Laura Bucci Valentina Santi Benedetta Stefanini Lorenzo Lani Davide Rampoldi Giorgia Ghittoni Fabio Farinati Alberto Masotto Bernardo Stefanini Andrea Mega Elisabetta Biasini Francesco Giuseppe Foschi Gianluca Svegliati-Baroni Angelo Sangiovanni Claudia Campani Giovanni Raimondo Gianpaolo Vidili Antonio Gasbarrini Ciro Celsa Mariella Di Marco Edoardo G. Giannini Rodolfo Sacco Maurizia Rossana Brunetto Francesco Azzaroli Donatella Magalotti Filomena Morisco Gian Ludovico Rapaccini Gerardo Nardone Alessandro Vitale Franco Trevisani Maurizio Biselli Paolo Caraceni Annagiulia Gramenzi Francesca Benevento Alessandro Granito Luca Muratori Fabio Piscaglia Francesco Tovoli Gloria Allegrini Calogero Cammà Giuseppe Cabibbo Carmelo Marco Giacchetto Paolo Giuffrida Maria Vittoria Grassini Mauro Grova Gabriele Rancatore Caterina Stornello Valentina Adotti Tancredi Li Cavoli Fabio Marra Martina Rosi Vittoria Bevilacqua Alberto Borghi Lucia Napoli Fabio Conti G.L. Frassineti Maria Teresa Migliano Gloria Allegrini Nicoletta de Matthaeis Francesca Romana Ponziani Gabriele Missale Andrea Olivani Mario Capasso Valentina Cossiga Maria Guarino Ester Marina Cela Antonio Facciorusso Camilla Graziosi Valentina Lauria Giorgio Pelecca Marta Schirripa Fabrizio Chegai Armando Raso Alessio Bozzi Maria Stella Franzè Carlo Saitta Assunta Sauchella Elton Dajti Federico Ravaioli Maria Corina Plaz Torres Giulia Pieri Filippo Oliveri Gabriele Ricco Veronica Romagnoli Alessandro Inno Fabiana Marchetti Pietro Coccoli Antonio Malerba Alberta Cappelli Rita Golfieri Cristina Mosconi Matteo Renzulli |
| author_sort | Nicola Reggidori |
| collection | DOAJ |
| description | Background & Aims: Alcohol abuse and metabolic disorders are leading causes of hepatocellular carcinoma (HCC) worldwide. Alcohol-related aetiology is associated with a worse prognosis compared with viral agents, because of the lower percentage of patients diagnosed with HCC under routine surveillance and a higher burden of comorbidity in alcohol abusers. This study aimed to describe the evolving clinical scenario of alcohol-related HCC over 15 years (2006–2020) in Italy. Methods: Data from the Italian Liver Cancer (ITA.LI.CA) registry were used: 1,391 patients were allocated to three groups based on the year of HCC diagnosis (2006–2010; 2011–2015; 2016–2020). Patient characteristics, HCC treatment, and overall survival were compared among groups. Survival predictors were also investigated. Results: Approximately 80% of alcohol-related HCCs were classified as cases of metabolic dysfunction-associated fatty liver disease. Throughout the quinquennia, <50% of HCCs were detected by surveillance programmes. The tumour burden at diagnosis was slightly reduced but not enough to change the distribution of the ITA.LI.CA cancer stages. Intra-arterial and targeted systemic therapies increased across quinquennia. A modest improvement in survival was observed in the last quinquennia, particularly after 12 months of patient observation. Cancer stage, HCC treatment, and presence of oesophageal varices were independent predictors of survival. Conclusions: In the past 15 years, modest improvements have been obtained in outcomes of alcohol-related HCC, attributed mainly to underuse of surveillance programmes and the consequent low amenability to curative treatments. Metabolic dysfunction-associated fatty liver disease is a widespread condition in alcohol abusers, but its presence did not show a pivotal prognostic role once HCC had developed. Instead, the presence of oesophageal varices, an independent poor prognosticator, should be considered in patient management and refining of prognostic systems. Impact and Implications: Alcohol abuse is a leading and growing cause of hepatocellular carcinoma (HCC) worldwide and is associated with a worse prognosis compared with other aetiologies. We assessed the evolutionary landscape of alcohol-related HCC over 15 years in Italy. A high cumulative prevalence (78%) of metabolic dysfunction-associated fatty liver disease, with signs of metabolic dysfunction, was observed in HCC patients with unhealthy excessive alcohol consumption. The alcohol + metabolic dysfunction-associated fatty liver disease condition tended to progressively increase over time. A modest improvement in survival occurred over the study period, likely because of the persistent underuse of surveillance programmes and, consequently, the lack of improvement in the cancer stage at diagnosis and the patients’ eligibility for curative treatments. Alongside the known prognostic factors for HCC (cancer stage and treatment), the presence of oesophageal varices was an independent predictor of poor survival, suggesting that this clinical feature should be carefully considered in patient management and should be included in prognostic systems/scores for HCC to improve their performance. |
| first_indexed | 2024-03-12T22:21:58Z |
| format | Article |
| id | doaj.art-994809fcb7eb4d6c91173f05293807e2 |
| institution | Directory Open Access Journal |
| issn | 2589-5559 |
| language | English |
| last_indexed | 2024-03-12T22:21:58Z |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHEP Reports |
| spelling | doaj.art-994809fcb7eb4d6c91173f05293807e22023-07-23T04:56:10ZengElsevierJHEP Reports2589-55592023-08-0158100784Landscape of alcohol-related hepatocellular carcinoma in the last 15 years highlights the need to expand surveillance programsNicola Reggidori0Laura Bucci1Valentina Santi2Benedetta Stefanini3Lorenzo Lani4Davide Rampoldi5Giorgia Ghittoni6Fabio Farinati7Alberto Masotto8Bernardo Stefanini9Andrea Mega10Elisabetta Biasini11Francesco Giuseppe Foschi12Gianluca Svegliati-Baroni13Angelo Sangiovanni14Claudia Campani15Giovanni Raimondo16Gianpaolo Vidili17Antonio Gasbarrini18Ciro Celsa19Mariella Di Marco20Edoardo G. Giannini21Rodolfo Sacco22Maurizia Rossana Brunetto23Francesco Azzaroli24Donatella Magalotti25Filomena Morisco26Gian Ludovico Rapaccini27Gerardo Nardone28Alessandro Vitale29Franco Trevisani30Maurizio BiselliPaolo CaraceniAnnagiulia GramenziFrancesca BeneventoAlessandro GranitoLuca MuratoriFabio PiscagliaFrancesco TovoliGloria AllegriniCalogero CammàGiuseppe CabibboCarmelo Marco GiacchettoPaolo GiuffridaMaria Vittoria GrassiniMauro GrovaGabriele RancatoreCaterina StornelloValentina AdottiTancredi Li CavoliFabio MarraMartina RosiVittoria BevilacquaAlberto BorghiLucia NapoliFabio ContiG.L. FrassinetiMaria Teresa MiglianoGloria AllegriniNicoletta de MatthaeisFrancesca Romana PonzianiGabriele MissaleAndrea OlivaniMario CapassoValentina CossigaMaria GuarinoEster Marina CelaAntonio FacciorussoCamilla GraziosiValentina LauriaGiorgio PeleccaMarta SchirripaFabrizio ChegaiArmando RasoAlessio BozziMaria Stella FranzèCarlo SaittaAssunta SauchellaElton DajtiFederico RavaioliMaria Corina Plaz TorresGiulia PieriFilippo OliveriGabriele RiccoVeronica RomagnoliAlessandro InnoFabiana MarchettiPietro CoccoliAntonio MalerbaAlberta CappelliRita GolfieriCristina MosconiMatteo RenzulliUnit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, ItalyUnit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, ItalyUnit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, ItalyUnit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, ItalyUnit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, ItalyUnit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, ItalyGastroenterology Unit, Belcolle Hospital, Viterbo, ItalyDepartment of Surgery, Oncology, and Gastroenterology, Gastroenterology Unit, University of Padova, Padua, ItalyGastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, ItalyDivision of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyGastroenterology Unit, Bolzano Regional Hospital, Bolzano, ItalyInfectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, ItalyMedicina Interna Faenza, Dipartimento Emergenza, Medicina Interna e Cardioloa IRCCS-Istituto Scientifico Romagnolo per lo Studio dei Tumori “Dino Amadori” Meldola, AUSL Romagna, Meldola, ItalyLiver Injury and Transplant Unit and Obesity Center, Polytechnic University of Marche, Ancona, ItalyFoundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, ItalyDepartment of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Florence, ItalyDepartment of Clinical and Experimental Medicine, Division of Medicine and Hepatology, University of Messina, Messina, ItalyDepartment of Medicine, Surgery and Pharmacy, AOU Sassari, ItalyInternal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS and Università Cattolica del Sacro Cuore, Rome, ItalySection of Gastroenterology and Hepatology, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, ItalyMedicina Ospedale Bolognini Seriate, ASST Bergamo Est, ItalyGastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy; Gastroenterology Unit, IRCCS Ospedale San Martino, Genoa, ItalyGastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, ItalyUO Epatologia, Azienda Ospedaliero Universitaria Pisana, Pisa, ItalyGastroenterology Unit, Department of Surgical and Medical Sciences, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, ItalyDivision of Internal Medicine, Neurovascular and Hepatometabolic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyDepartment of Clinical Medicine and Surgery, Departmental Program “Diseases of the Liver and Biliary System”, University of Napoli “Federico II”, Naples, ItalyFacoltà di Medicina e Chirurgia, Università Cattolica del S. Cuore, Rome, ItalyDepartment of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli “Federico II”, Naples, ItalyDepartment of Surgical, Oncological, and Gastroenterological Sciences, Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, ItalyUnit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy; Corresponding author. Address: Dipartimento di Scienze Mediche e Chirurgiche, Semeiotica Medica, Via Albertoni 15, 40138, Bologna, Italy. Tel.: +39 051 214 2023; fax: +39 051 636 2930.Background & Aims: Alcohol abuse and metabolic disorders are leading causes of hepatocellular carcinoma (HCC) worldwide. Alcohol-related aetiology is associated with a worse prognosis compared with viral agents, because of the lower percentage of patients diagnosed with HCC under routine surveillance and a higher burden of comorbidity in alcohol abusers. This study aimed to describe the evolving clinical scenario of alcohol-related HCC over 15 years (2006–2020) in Italy. Methods: Data from the Italian Liver Cancer (ITA.LI.CA) registry were used: 1,391 patients were allocated to three groups based on the year of HCC diagnosis (2006–2010; 2011–2015; 2016–2020). Patient characteristics, HCC treatment, and overall survival were compared among groups. Survival predictors were also investigated. Results: Approximately 80% of alcohol-related HCCs were classified as cases of metabolic dysfunction-associated fatty liver disease. Throughout the quinquennia, <50% of HCCs were detected by surveillance programmes. The tumour burden at diagnosis was slightly reduced but not enough to change the distribution of the ITA.LI.CA cancer stages. Intra-arterial and targeted systemic therapies increased across quinquennia. A modest improvement in survival was observed in the last quinquennia, particularly after 12 months of patient observation. Cancer stage, HCC treatment, and presence of oesophageal varices were independent predictors of survival. Conclusions: In the past 15 years, modest improvements have been obtained in outcomes of alcohol-related HCC, attributed mainly to underuse of surveillance programmes and the consequent low amenability to curative treatments. Metabolic dysfunction-associated fatty liver disease is a widespread condition in alcohol abusers, but its presence did not show a pivotal prognostic role once HCC had developed. Instead, the presence of oesophageal varices, an independent poor prognosticator, should be considered in patient management and refining of prognostic systems. Impact and Implications: Alcohol abuse is a leading and growing cause of hepatocellular carcinoma (HCC) worldwide and is associated with a worse prognosis compared with other aetiologies. We assessed the evolutionary landscape of alcohol-related HCC over 15 years in Italy. A high cumulative prevalence (78%) of metabolic dysfunction-associated fatty liver disease, with signs of metabolic dysfunction, was observed in HCC patients with unhealthy excessive alcohol consumption. The alcohol + metabolic dysfunction-associated fatty liver disease condition tended to progressively increase over time. A modest improvement in survival occurred over the study period, likely because of the persistent underuse of surveillance programmes and, consequently, the lack of improvement in the cancer stage at diagnosis and the patients’ eligibility for curative treatments. Alongside the known prognostic factors for HCC (cancer stage and treatment), the presence of oesophageal varices was an independent predictor of poor survival, suggesting that this clinical feature should be carefully considered in patient management and should be included in prognostic systems/scores for HCC to improve their performance.http://www.sciencedirect.com/science/article/pii/S2589555923001155Hepatocellular carcinomaAlcohol abuseITA.LI.CA staging systemMetabolic dysfunction-associated fatty liver diseaseSurveillance programsOesophageal varices |
| spellingShingle | Nicola Reggidori Laura Bucci Valentina Santi Benedetta Stefanini Lorenzo Lani Davide Rampoldi Giorgia Ghittoni Fabio Farinati Alberto Masotto Bernardo Stefanini Andrea Mega Elisabetta Biasini Francesco Giuseppe Foschi Gianluca Svegliati-Baroni Angelo Sangiovanni Claudia Campani Giovanni Raimondo Gianpaolo Vidili Antonio Gasbarrini Ciro Celsa Mariella Di Marco Edoardo G. Giannini Rodolfo Sacco Maurizia Rossana Brunetto Francesco Azzaroli Donatella Magalotti Filomena Morisco Gian Ludovico Rapaccini Gerardo Nardone Alessandro Vitale Franco Trevisani Maurizio Biselli Paolo Caraceni Annagiulia Gramenzi Francesca Benevento Alessandro Granito Luca Muratori Fabio Piscaglia Francesco Tovoli Gloria Allegrini Calogero Cammà Giuseppe Cabibbo Carmelo Marco Giacchetto Paolo Giuffrida Maria Vittoria Grassini Mauro Grova Gabriele Rancatore Caterina Stornello Valentina Adotti Tancredi Li Cavoli Fabio Marra Martina Rosi Vittoria Bevilacqua Alberto Borghi Lucia Napoli Fabio Conti G.L. Frassineti Maria Teresa Migliano Gloria Allegrini Nicoletta de Matthaeis Francesca Romana Ponziani Gabriele Missale Andrea Olivani Mario Capasso Valentina Cossiga Maria Guarino Ester Marina Cela Antonio Facciorusso Camilla Graziosi Valentina Lauria Giorgio Pelecca Marta Schirripa Fabrizio Chegai Armando Raso Alessio Bozzi Maria Stella Franzè Carlo Saitta Assunta Sauchella Elton Dajti Federico Ravaioli Maria Corina Plaz Torres Giulia Pieri Filippo Oliveri Gabriele Ricco Veronica Romagnoli Alessandro Inno Fabiana Marchetti Pietro Coccoli Antonio Malerba Alberta Cappelli Rita Golfieri Cristina Mosconi Matteo Renzulli Landscape of alcohol-related hepatocellular carcinoma in the last 15 years highlights the need to expand surveillance programs JHEP Reports Hepatocellular carcinoma Alcohol abuse ITA.LI.CA staging system Metabolic dysfunction-associated fatty liver disease Surveillance programs Oesophageal varices |
| title | Landscape of alcohol-related hepatocellular carcinoma in the last 15 years highlights the need to expand surveillance programs |
| title_full | Landscape of alcohol-related hepatocellular carcinoma in the last 15 years highlights the need to expand surveillance programs |
| title_fullStr | Landscape of alcohol-related hepatocellular carcinoma in the last 15 years highlights the need to expand surveillance programs |
| title_full_unstemmed | Landscape of alcohol-related hepatocellular carcinoma in the last 15 years highlights the need to expand surveillance programs |
| title_short | Landscape of alcohol-related hepatocellular carcinoma in the last 15 years highlights the need to expand surveillance programs |
| title_sort | landscape of alcohol related hepatocellular carcinoma in the last 15 years highlights the need to expand surveillance programs |
| topic | Hepatocellular carcinoma Alcohol abuse ITA.LI.CA staging system Metabolic dysfunction-associated fatty liver disease Surveillance programs Oesophageal varices |
| url | http://www.sciencedirect.com/science/article/pii/S2589555923001155 |
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