NATURAL-HISTORY OF HEPATOCELLULAR-CARCINOMA IN NORTHERN ITALY - MULTIVARIED ANALYSIS OF PROGNOSTIC FACTORS

Only few investigations have used multivaried analysis to evaluate the role of different prognostic factors in untreated patients with hepat ocellular carcinoma (HCC). In this retrospective study we evaluated th e predictive value of nine variables - obtained at the diagnosis - in relation to the survival of 130 unselected untreated HCC patients dete cted over a ten-year period in the province of Bergamo in northern Ita ly. The overall mean survival was 23 weeks (range 1-128): after six mo nths, 41 patients were alive (31.5%) and after one year 15 (11.5%). Fo ur of the nine variables (alcoholism, presenting symptoms, alphafetopr otein and bilirubin serum levels) demonstrated, in the univaried analy sis, a statistically significant prognostic value on the survival rate . However, the multivaried analysis, using the Cox model, selected onl y two of them as independent prognostic factors: the presenting sympto ms (p = 0.0017) and the bilirubin serum level (p = 0.0033). Age, sex, cirrhosis, HBsAg+ and tumor pathological classification (by Eggel) did not show any predictive value. These results confirm the poor prognos is of HCC in unselected patients, and demonstrate that, even today, a large number of hepatocellular carcinomas is diagnosed at an advanced stage of the disease when the chances of treatment are limited and the survival short. In the clinical practice a simple evaluation of the p atients at the diagnosis proves to be useful in roughly appraising the ir prognosis before any therapeutical approach.