Clinical features and survival of patients with hepatocellular carcinoma at a cancer treatment facility

Farhana Badar,Hala Mansoor,Kashif Siddique,Muhammad Adnan Masood,Muhammed Aasim Yusuf

doi:10.15419/bmrat.v6i11.577

Abstract

Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths. This study aimed to determine the survival of patients with HCC at our treatment facility. Methods: We retrospectively studied 278 patients with HCC who were seen between 2007 and 2013. Of these patients, 84.4% had evidence of prior infection with hepatitis C, while 7.8% had markers of hepatitis B infection. Results: Median survival was 24.6 months for transarterial chemoembolization (TACE), 61 months for ablative therapies, and 31.5 months for those undergoing surgical resection. Increasing tumor size, multifocality, advanced Barcelona clinic liver cancer (BCLC) stage, and poor liver function (Child-Pugh class B-C) were significantly associated with worse prognosis; pvalues were 0.002, 0.009, <0.001, and <0.001, respectively. Conclusion: Most patients in our series presented with advanced liver disease, with multifocal tumors and were candidates for palliative treatment only. Public education to minimize hepatitis B and C transmission, screening programs to detect disease at an earlier stage, and the development of specialist liver units and liver transplant programs can bring a change in HCC survival in developing countries.

Highlights

Hepatocellular carcinoma (HCC) is common, and it affects different regions of the world disproportionately, worldwide it remains the seventh most frequent cancer and the third most common cause of cancer-related deaths, causing approximately 600,000 deaths annually . 1–3 Its incidence has almost doubled in Western countries in the past 20 years, primarily due to an increase in alcohol and hepatitis C-related liver cirrhosis 4,5
The median survival of patients who had an ablative procedure was 61 months, while in those who had transarterial chemoembolization (TACE) in combination with another treatment modality, it was 44 months
Median survival was 31.5 months for those undergoing surgical resection, 24.6 months in those who underwent TACE, 9.6 months in those treated with sorafenib, and 3.6 months for those on supportive care

Summary

Introduction

Hepatocellular carcinoma (HCC) is common, and it affects different regions of the world disproportionately, worldwide it remains the seventh most frequent cancer and the third most common cause of cancer-related deaths, causing approximately 600,000 deaths annually . 1–3 Its incidence has almost doubled in Western countries in the past 20 years, primarily due to an increase in alcohol and hepatitis C-related liver cirrhosis 4,5. With universal screening of high risk populations, early detection and treatment, the five-year survival rate of those with HCC can be as high as 70%, after ablation, resection or liver transplant. Patients in whom HCC is detected by surveillance have a three-year survival rate of 50.8%, compared to 28.2% in those not on a surveillance program. This difference in survival is largely due to detection at an earlier stage, with better resultant treatment options 7. Public education to minimize hepatitis B and C transmission, screening programs to detect disease at an earlier stage, and the development of specialist liver units and liver transplant programs can bring a change in HCC survival in developing countries.

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