Epidemiology and Survival of Hepatocellular Carcinoma in the Central Region of Thailand

  • Published : 2014.04.30


Background: Hepatocellular carcinoma (HCC) is one of the most common cancers in men and the third most common cancer in woman in Thailand. This retrospective study was designed to assess the prevalence, clinical manifestations, treatment outcomes and prognosis of HCC in the central region of Thailand. Materials and Methods: The authors retrospectively reviewed all HCC patients aged more than 15 years old in Thammasat university hospital (TUH) during the period from January 2007 to December 2012. Clinical information, biochemical tests and radiologic findings were collected from review of medical records. Results: There were 308 patients with HCC, which accounted for the prevalence of 5.19% of all cancers diagnosed in TUH during the study period. Of these, 125 (40.5%) had complete information retrievable from their medical records and met the inclusion criteria, 99 (79.2%) were males. The mean age was 57.4 years. A quarter of HCC patients in this study presented without any symptom before diagnosis. The common clinical presentations in the remaining patients were hepatomegaly 64/125 (51.2%), abdominal pain 56/125 (44.8%) and ascites 16/125 (20.8%). Cirrhosis was seen in almost all patients (92.8%). The most common causes of HCC in this study were chronic hepatitis B (49.6%) and C (19.2%). Based on Barcelona Clinic Liver Cancer staging, 75.4% presented at intermediate or late stage. Patients receiving curative therapy with either surgical treatment or radiofrequency ablation had significantly longer survival time after the HCC diagnosis than the palliative therapy group (11.0 months vs 4.0 months, p value= 0.004). The mean survival time after the HCC diagnosis was 10.5 months. Conclusions: The common causes of HCC in central region of Thailand were chronic hepatitis B and C. Surgical therapy or RFA seemed to provide better outcomes than other treatments but only in patients with early stage lesions. Most of the patients in this study presented with advanced diseases and had grave prognosis. Appropriate screening patients at risk for HCC might be an appropriate way to achieve early diagnosis and improve the treatment outcome.


  1. Yang HI, Lu SN, Liaw YF, You SL, Sun CA, Wang LY, Hsiao CK, Chen PJ, Chen DS, Chen CJ (2002). Hepatitis B eantigen and the risk of hepatocellular carcinoma. N Engl J Med, 347, 168-74.
  2. Singa AG, Nehra M, Adams-Huet B, et al (2013). Detection of hepatocellular carcinoma at advanced stages among patients in the HALT-C trial: where did surveillance fail? Am J Gastroenterol, 108, 425-32.
  3. Sithinamsuwan P, Piratvisuth T, Tanomkiat W, Apakupakul N, Tongyoo S (2000). Review of 336 patients with hepatocellular carcinoma at Songklanagarind Hospital. World J Gastroenterol, 6, 339-43.
  4. Wiangnon S, Kamsa-ard S, Suwanrungruang K, et al (2012). Trends in incidence of hepatocellular carcinoma, 1990-2009, Khon Kaen, Thailand. Asian Pac J Cancer Prev, 13, 1065-8.
  5. Yeo Y, Gwack J, Kang S, et al (2013). Viral hepatitis and liver cancer in Korea: an epidemiological perspective. Asian Pac J Cancer Prev, 14, 6227-31.
  6. Forner A, Llovet JM, Bruix J (2012). Hepatocellular carcinoma. Lancet, 379, 1245-55.
  7. Bruix J, Sherman M (2005). Management of hepatocellular carcinoma. Hepatol, 42, 1208-36
  8. de Lope CR, Tremosini S, Forner A, Reig M, Bruix J (2012). Management of HCC. J Hepatol, 56, 75-87.
  9. El-Serag HB (2011). Hepatocellular carcinoma. N Engl J Med, 365, 1118-27.
  10. Keyvan H, Fazlalipour M, Monavari SH, Mollaie HR (2012). Hepatitis C virus-proteins, diagnosis, treatment and new approaches for vaccine development. Asian Pac J Cancer Prev, 13, 5931-49.
  11. Liang T, Chen EQ, Tang H (2013). Hepatitis B virus gene mutations and hepatocarcinogenesis. Asian Pac J Cancer Prev, 14, 4509-13.
  12. Llovet JM, Bru C, Bruix J (1999). Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis, 19, 329-38.
  13. Marrero JA, Fontana RJ, Barrat A, et al (2005). Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology, 41, 707-16.
  14. Norsa'adah B, Nurhazalini-Zayani CG (2013). Epidemiology and survival of hepatocellular carcinoma in north-east Peninsular Malaysia. Asian Pac J Cancer Prev, 14, 6955-9.
  15. Parkin DM, Bray F, Ferlay J, Pisani P (2005). Global cancer statistics, 2002. CA Cancer J Clin, 55, 74-108.
  16. Pourhoseingholi MA , Fazeli Z, Zali MR, Alavian SM (2010). Burden of hepatocellular carcinoma in Iran; Bayesian projection and trend analysis. Asian Pac J Cancer Prev, 11, 859-62.
  17. Alazawi W, Cunningham M, Dearden J, Foster GR (2010). Systematic review: outcome of compensated cirrhosis due to chronic hepatitis C infection. Aliment Pharmacol Ther, 32, 344-55.
  18. Belghiti J, Fuks D (2012). Liver resection and transplantation in hepatocellular carcinoma. Liver Cancer, 1, 71-82.
  19. Bruix J, Sherman M (2011). Management of hepatocellular carcinoma: an update. Hepatology, 53, 1020-2.

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