A concise review on the frequency, major risk factors and surveillance of hepatocellular carcinoma (HCC) in β-thalassemias: Past, present and future perspectives and the ICET - A experience

Vincenzo De Sanctis*, Ashraf T. Soliman, Shahina Daar, Niveen Alansary, Antonis Kattamis, Myrto Skafida, Maria Concetta Galati, Soteroula Christou, Saveria Campisi, Giuseppe Messina, Mohamed A. Yassin, Duran Canatan, Salvatore Di Maio, Soad Al Jaouni, Giuseppe Raiola, Mehran Karimi, Valeria Kaleva, Shruti Kakkar, Demetris Mariannis, Christos Kattamis

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Citations (Scopus)


Due to the recent alarming increase in the incidence of hepatocellular carcinoma (HCC) in thalassemias, the present report reviews briefly the frequency, the major risk factors, and the surveillance of HCC in β-thalassemias. Over the past 33 years, 153 cases of HCC were reported in patients with thalassemia, mainly in Italy and Greece. Among HCV-infected patients, additional factors promoting the development of HCC included: advanced age, male sex, chronic hepatitis B (CHB) co-infection, and iron overload. For early diagnosis of HCC, sequential ultrasound screening is recommended especially for thalassemia patients with chronic hepatitis C (CHC), which coincides with (one or more) additional risk factors for HCC. Here we report also the preliminary data from thalassemic patients, above the age of 30 years, followed in 13 ICET-A centers. The total number of enrolled patients was 1,327 (males: 624 and 703 females). The prevalence of HCC in thalassemia major patients [characterized by transfusion-dependency (TDT)] and thalassemia intermedia [characterized by nontransfusion dependency (NTDT)] was 1.66 % and 1.96 %, respectively. The lowest age at diagnosis of HCC was 36 years for TDT and 47 years for NTDT patients. We hope that this review can be used to develop more refined and prospective analyses of HCC magnitude and risk in patients with thalassemia and to define specific international guidelines to support clinicians for early diagnosis and treatment of HCC in thalassemic patients.

Original languageEnglish
Article numbere2020006
JournalMediterranean Journal of Hematology and Infectious Diseases
Issue number1
Publication statusPublished - 2020
Externally publishedYes


  • Hepatocellular carcinoma
  • Risk factors
  • Surveillance
  • Thalassemias

ASJC Scopus subject areas

  • Hematology
  • Infectious Diseases

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