Abstract
Objective:To identify the stage of Hepatocellular Carcinoma (HCC) at the time of presentation.Methods:This cross sectional observational prospective study was carried out at Gastro Department of Combined Military Hospital (CMH) Multan from August 2017 to December 2018. Patients were diagnosed on the basis of alpha fetoprotein, abdominal ultrasound, triphasic contrast enhanced computerized tomography (CECT). They were evaluated for etiology including Hepatitis B, C and non B & C. The patients were inquired about the previous treatment and when they came to know about the HCC. Staging of the tumor was done on the basis BCLC (Barcelona cancer liver clinic) and Melan’s criteria. Performance status (PS) of the patient was checked by Eastern Cooperative Oncology Group (ECOG) criteria. Severity of cirrhosis was assessed by CTP (Child Turcotte Pugh) and Model for end stage liver disease (MELD) score. The data was analyzed in IBM SPSS version 22.Results:Out of 135 patients 78% were males and 22% females. Age Mean SD was 58.81± 9.366. Frequency of hepatitis C, B, combined B, C and non-B non-C was 80%, 11%, 2.8% and 6.2% respectively. 96(73.8%) never got the treatment before for Hepatitis. 81(62.3%) came to know first time on this index admission. Maximum numbers of patients were in BCLC stage B i.e. 82(55.2%) with ECOG grade of one i.e.57 (39.3%), at the time of presentation. Mean MELD and CTP score were 12.24, 7.34 (class B) respectively.Conclusion:HCV was the most common in HCC, never treated before, presented for the first time in advance stage of the disease where very limited treatment options left behind.
Highlights
Hepatocellular carcinoma was the second most common cancer death in males and 7th amongst females in 2012 worldwide.[1,2,3] In Pakistan frequency of hepatobiliary malignancy in males is 10.7% of all cancers.[4]
Frequencies of patients according to gender, hepatitis status, treatment status, time since diagnosis of hepatocellular carcinoma, child class, BCLC staging and Eastern Cooperative Oncology Group (ECOG) performance status were determined
Patient Characteristics as per BCLC Staging have been shown in Table-II and III
Summary
Hepatocellular carcinoma was the second most common cancer death in males and 7th amongst females in 2012 worldwide.[1,2,3] In Pakistan frequency of hepatobiliary malignancy in males is 10.7% of all cancers.[4]. In two different studies frequency of HCC in Pakistan secondary to HCV is 87%, 66% and in HBV 22% and 43% has been reported.[5] This deadly complication can be prevented by putting the patients at risk in regular surveillance programme.[6] According to American association for the study of liver disease (AASLD) guidelines any mass in Chronic Liver. Disease (CLD) patients is likely HCC.[7] AASLD and European Association for the study of liver (EASL) disease recommends six monthly Ultrasound liver and serum AFP to avoid missing fresh cases.[8] In this era of high public awareness and social media still our patients are ignorant about the serious consequences of hepatitis. Less than 10% HCC patients are diagnosed with screening in Pakistan.[9,10] This fact has been pointed out in a number of studies but there are very few studies that exactly quantify this issue, that’s why this study was done to identify the stage at presentation of HCC in our population in order to increase awareness among health professionals to be vigilant to identify HCC earlier so that curative options of treatment can be exercised
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