GROSS PATHOLOGICAL TYPES OF HEPATOCELLULAR-CARCINOMA IN ITALIAN PATIENTS - RELATIONSHIP WITH DEMOGRAPHIC, ENVIRONMENTAL, AND CLINICAL FACTORS

Background. The prevalence of the different hepatocellular carcinoma ( HCC) macroscopic types, and the association between these types and ag e, gender, blood group, alcohol and coffee intake, smoking habit, hepa titis virus markers, underlying cirrhosis, and cancer histologic type were retrospectively assessed in 416 unselected patients (321 with cir rhosis). Methods. The gross pathologic types of HCC were assessed by u ltrasonography combined, in most cases, with computed tomography and a ngiography. Results. Solitary HCC was the most common cancer type (54. 8%), followed by the multinodular (31%), diffuse (7.7%), and massive ( 6.5%) types. Cirrhosis and blood group other than O were independent r isk factors for multimodular HCC (relative risk [RR] 1.6, P < 0.05; an d RR 1.7, P < 0.005, respectively); the absence of cirrhosis and a hea vy smoking habit were risk factors for the massive type (RR 4.9, P < 0 .001; and RR 3.3, P < 0.01, respectively); and blood group 0 for the s olitary type (RR 1.4, P < 0.001). The prevalence of highly undifferent iated cells increased as the tumor size did, so that grade IV cell aty pia was associated with massive size of the carcinoma (P < 0.05). In c irrhotic patients, advanced liver dysfunction was associated with diff use HCC (P < 0.05). As far as solitary HCC is concerned, the tumor siz e was greater in noncirrhotic than in cirrhotic patients (7 +/- 0.4 cm versus 4.8 +/- 0.15, P < 0.001). Conclusions. In Italian patients, HC C presents most frequently as a solitary nodule. The presence or absen ce of cirrhosis, blood group, and smoking habit can influence the like lihood of developing certain HCC shapes. The probability of harboring highly undifferentiated cells increases as the cancer increases in siz e. In cirrhosis, advanced liver dysfunction may predispose to diffuse HCC.