Causes and Stages of Hepatocellular Carcinoma at Patient Presentation at a Tertiary Medical Center in Western Saudi Arabia

Abstract

Background: With 748,300 new cases diagnosed every year, hepatocellular carcinoma (HCC) is the 5th and the 7th most common cancer among males and females, respectively, and causes 7% of all cancer-related deaths. HCC represents more than 90% of primary liver cancers. Objective: The aim of the present study was to recognize the stages of HCC at presentation in patients who were diagnosed at King Abdul Aziz University Hospital (KAUH) and to identify the associated laboratory features of advance HCC. Materials and Methods: A retrospective analysis of 57 HCC patients admitted to KAUH between January 2008 and December 2012 was conducted. The diagnosis was established using ultrasound (U/S), computed tomography (CT) and/or magnetic resonance imaging (MRI), with or without a liver biopsy, as well as blood testing for alpha-fetoprotein. The following data were extracted from the medical records at KAUH: patient demographics (age, sex and nationality), laboratory results (CBC, LFT, PT, INR and alpha-fetoprotein), radiological results, biopsy results for those patients who underwent biopsy, outcomes (living, deceased or lost from the follow-up), and mortality and survival rates. Results: A total of 57 HCC patients were admitted during the study period, and 3 patients were excluded from the analysis. Of the remaining 54 patients, 44 (81.5%) were males and 10 (18.5%) were females. The mean age was 64.54 years (SD, 11.2 years; range, 31 - 86 years). The majority of patients were Saudis (19, 35.2%), non-Saudis (35, 64.8%), Egyptians (9, 16.6%) and Yemenis (7, 13%). The remaining 19 (35.2%) patients comprised other nationalities. Chronic hepatitis C virus was the most common cause for liver cirrhosis (35 patients, 64.8%). CT was the primary diagnostic method (37 patients 68.5%), while 9 (16.7%) cases were confirmed by adnominal MRI. Six patients (11.1%) were diagnosed with abdominal ultrasound examination and elevated alpha-fetoprotein levels. In 2 (3.7%) patients, HCC was confirmed by liver biopsy. The majority of the patients (37, 68.5%) had advanced disease. Only 21 (39%) patients underwent radio frequency appellation (RFA). The mean survival time from diagnosis to death was 5.9 months (SD, 5.7 months), and the longest survival time to death was 20 months. Conclusion: The majority of our patients presented at an advanced disease stage, and CHC was the most common underlying cause for liver cirrhosis in our cohort of HCC patients. The proper implementation of HCC screening programs for cirrhotic patients is expected to help detect the treatable stages of HCC in a timely manner.