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Puoti. Hepatoma Res 2018;4:57 Hepatoma Research
DOI: 10.20517/2394-5079.2018.67

Review Open Access

New insights on hepatocellular carcinoma:
epidemiology and clinical aspects

Claudio Puoti
Liver Unit, INI Research Institute and Clinics Grottaferrata, Rome 00046, Italy.

Correspondence to: Dr. Claudio Puoti, Liver Unit, INI Research Institute and Clinics Grottaferrata, Rome, Italy.
Email address: puoti@epatologia.org

How to cite this article: Puoti C. New insights on hepatocellular carcinoma: epidemiology and clinical aspects. Hepatoma Res 2018;4:57.
http://dx.doi.org/10.20517/2394-5079.2018.67

Received: 25 May 2018 First Decision: 17 Jul 2018 Revised: 29 Jul 2018 Accepted: 1 Aug 2018 Published: 21 Sep 2018
Science Editor: Guang-Wen Cao Copy Editor: Cai-Hong Wang Production Editor: Zhong-Yu Guo

Abstract
Primary liver cancer represents the 4th most common tumor in males (4% of all cancers) and the 7th most
common tumor in females (2.3% of all cancers), with a prevalence of 53/100,000 in males and 22/100,000 in
females (male-to-female ratio = 2:1). In the majority of the cases, hepatocellular carcinoma (HCC) develops in
patients with cirrhosis and thus the risk factors for HCC and chronic liver disease are overlapping. Viral infections
(hepatitis B virus, hepatitis C virus), alcohol and fat (nonalcoholic fatty liver disease/non-alcoholic steatohepatitis)
represent the main risk factors for development of HCC on cirrhotic liver. Several prospective studies reported
that at present HCC does represent the first cause of death of cirrhotic patients, while in the past morbidity and
mortality in cirrhosis were mainly determined by other non-neoplastic complications of the disease. From a clinical
point of view, staging systems in HCC should define outcome prediction and treatment assignment. Due to the
nature of HCC, the main prognostic variables are the tumor stage, liver function and performance status. The most
accepted clinical classification of HCC has been proposed by the Barcelona Clinic Liver Cancer. The BCLC staging
system has come to be widely accepted in clinical practice and is also being used for many clinical trials of new
drugs to treat HCC. Therefore, it has become the de facto staging system that is used.

Keywords: Alcohol, cirrhosis, hepatitis B virus, hepatocellular carcinoma, hepatitis C virus, non-alcoholic
steatohepatitis

INTRODUCTION
Hepatocellular carcinoma (HCC) represents one of the most common human neoplasm, being one of the
[1,2]
leading mortality worldwide . The main feature of HCC consists in that it affects mostly patients with liver

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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