NATURAL-HISTORY OF ADVANCED HEPATOCELLULAR-CARCINOMA IN CRETE - ASSOCIATION WITH HEPATITIS-C VIRUS

Objective: To investigate the clinical characteristics of advanced hep atocellular carcinoma (HCC) in Crete and to analyse the natural course of the untreated disease. Participants: Seventy-three patients (62 me n) were enrolled in a prospective 4-year study. Clinical and virologic al parameters were recorded. Diagnosis was based on either ultrasound guided liver biopsy or a pathognomonic increase in alpha-fetoprotein p lus compatible imaging. Methods: Statistical analysis was performed us ing histograms, contingency tables and one-way analyses of variance to analyse the characteristics of the disease. For survival analysis Kap lan-Meier survival curves and Cox's proportional hazards models were c onstructed. Results: HCC in Crete is a mostly male disease (7:1 male:f emale ratio) and unlike in mainland Greece, it is mostly a hepatitis C virus (HCV)-related disease (54% HCV positive as opposed to only 13% in mainland Greece). Prognosis was associated with Okuda classificatio n (Okuda stage III patients have a relative risk of dying that is seve n to nine times higher than for Okuda stage I), the presence or absenc e of hepatitis B e antigen (HBeAg) and antibody to hepatitis B core an tigen (anti-HBc). By contrast the presence of anti-HCV was not associa ted with a worse prognosis. A unit increase of albumin concentration w as associated with an 11% decrease in the hazard rate. Conclusion: In general, Crete, despite the extremely similar population to the rest o f Greece, resembles more closely the situation in Spain or Italy rathe r than mainland Greece.