The role of coffee in the aetiology of hepatocellular carcinoma has raised great interest. In Italy, coffee consumption is high, thus allowing the investigation of the topic over a broad range of consumption. A hospital-based case-control study was conducted in Italy in [1999][2000][2001][2002], including 185 incidents, histologically confirmed cases of hepatocellular carcinoma aged 43-84 years. Controls were 412 subjects admitted to the same hospitals' networks for acute, non-neoplastic diseases unrelated to diet. Coffee and tea consumption were assessed using a validated food-frequency questionnaire. Odds ratios (ORs) and corresponding the 95% confidence intervals (CI) were computed using unconditional multiple logistic regression, adjusting for hepatitis viruses seropositivity, alcohol intake, smoking habits and other potential confounding factors. Compared to people who drunk <14 cups/week of coffee, the risk of hepatocellular carcinoma decreased for increasing levels of consumption (OR 5 0.4, 95% CI: 0.2-1.1 for 28 cups/week, p for trend 5 0.02). In the present study, inverse relations were observed across strata of hepatitis C and B virus infections and alcohol drinking. No significant association emerged with consumption of decaffeinated coffee (OR 5 0.7, 95% CI 5 0.2-2.5) or tea (OR 5 1.4, 95% CI 5 0.8-2.7). The present study supports the hypothesis of a favourable effect of coffee, though not decaffeinated coffee and tea, on the risk on hepatocellular carcinoma. ' 2006 Wiley-Liss, Inc.Key words: coffee; tea; hepatocellular carcinoma; case-control study Hepatocellular carcinoma (HCC) is a highly fatal cancer that, in Italy, accounts for 3.4% of all newly diagnosed cancers among men and for 1.9% among women. 1 Likewise, the burden of HCC on total cancer mortality was 4.4% among men and 2.7% among women. 2 Incidence and mortality have shown upward trends in most of the developed countries, 3-5 including Italy. 3 The major known risk factors are persistent infections with hepatitis C virus (HCV) and hepatitis B virus (HBV), 6 but other prevalent medical conditions (i.e., liver cirrhosis) or socio-demographic factors, such as alcohol drinking and tobacco smoking, may play an important role in HCC onset. 6,7 Several studies from Europe, Japan, and United States reported an inverse relation between coffee consumption, g-glutamyltransferase (GGT) 8-10 and alanine aminotransferase (ALT) 10,11 levels, which are markers of liver injuries. Recently, increasing evidence has emerged on the relation between coffee drinking and risk of cirrhosis 12-14 and HCC. [15][16][17][18] A consistent inverse association with coffee consumption against HCC was found in cohort 15,[17][18][19] and case-control studies. 16,20,21 A few studies have investigated tea consumption in relation to HCC incidence and mortality, 14,15,19,22 and their results were inconclusive.Italy ranked among the top European countries according to annual pro-capite consumption of coffee (about 6 kg) (www.ico.org). The present paper, based on a case-control ...