Abstract
Egypt is one of the hot spots in the international map of Hepatocellular carcinoma (HCC), which is where hepatitis C virus (HCV) infection is the major risk factor in development of HCC (80%). Due to low organ donation rates and lack of deceased liver transplantation, hepatic resection is the main line of treatment for HCC patients with sufficient liver reserve. We introduce our experience with patients who had HCV related HCC who underwent hepatic re-section to determine various predictors of tumour recurrence in this group. This is the first study to come from a country where chronic HCV hepatitis is endemic. This is a retrospective cohort study of 208 cases of HCC in hepatitis C virus positive patients with cirrhotic livers who underwent first-time liver resection, in Gastroenterology Surgical Centre, Mansoura University, Egypt during the period from January 2002 to December 2011. Shapiro-Wilk test was used to assess normality of data. Predictors of HCC recurrence were assessed by bivariate correlation tests, univariate analysis using the chi-square and t-test and binary logistic regression analysis. A P value <0.05 was considered statistically significant. Tumour recurrence occurred in 88 patients (42.3%). Most of the recurrences occurred within the first year 55 patients (62.5%). The most common site for recurrence was the liver (n=68, 77.3%). Based on the univariate analysis; significant variables predicting tumor recurrence were alpha feto-protein (AFP), blood transfusion, multi-focality, cut margin, microvascular invasion, lack of capsule, tumour grade and stage. Based on multivariate analysis, the main variables predicting tumor recurrence were blood transfusion, cut margin, tumour capsule and microvascular invasion. Although the predictors of recurrence are the same for both HBV and HCV related HCC, the rate and aggressiveness of recurrence are higher in HCV related HCC.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide, and the third most common aetiology of cancer-associated mortality [1]
Conclusion: the predictors of recurrence are the same for both hepatitis B virus (HBV) and hepatitis C virus (HCV) related HCC, the rate and aggressiveness of recurrence are higher in HCV related HCC
In countries with a high incidence of HCC owing to endemic viral hepatitis, low organ donation rates and lack of deceased liver transplantation, primary hepatic resection is the first line of treatment for HCC patients with sufficient liver reserve [4]
Summary
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide, and the third most common aetiology of cancer-associated mortality [1]. The incidence of HCC in the Europe is 8.29/100 000, while in Asia and Africa it is 120/100 000 owing to high rates of viral hepatitis (B and C) [2]. Hepatic resection and liver transplantation are the main lines of curative treatment for HCC [1]. In countries (such as Egypt) with a high incidence of HCC owing to endemic viral hepatitis, low organ donation rates and lack of deceased liver transplantation, primary hepatic resection is the first line of treatment for HCC patients with sufficient liver reserve [4]. We introduce our experience after long term follow-up of patients who underwent hepatic resection for HCV related HCC in cirrhotic liver
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