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Hepatocellular Carcinoma in a Tertiary Referral Hospital in Indonesia: Lack of Improvement of One-Year Survival Rates between 1998-1999 and 2013-2014

  • Loho, Imelda M (Internal Medicine Department, Faculty of Medicine, Universitas Indonesia) ;
  • Hasan, Irsan (Internal Medicine Department, Faculty of Medicine, Universitas Indonesia) ;
  • Lesmana, C Rinaldi A (Internal Medicine Department, Faculty of Medicine, Universitas Indonesia) ;
  • Dewiasty, Esthika (Internal Medicine Department, Faculty of Medicine, Universitas Indonesia) ;
  • Gani, Rino A (Internal Medicine Department, Faculty of Medicine, Universitas Indonesia)
  • Published : 2016.06.01

Abstract

Background: The survival of hepatocellular carcinoma (HCC) patients is usually low due to late diagnosis. Cipto Mangunkusumo Hospital as the largest tertiary referral hospital in Indonesia, has recently improved its modalities for advanced HCC management, but there has not been any evaluation on any improvement in HCC patient survival. Materials and Methods: A retrospective analysis on 114 HCC patients in 2013-2014 were conducted and compared with the database for 77 HCC patients in 1998-1999. Clinical characteristics and treatment received were recorded and the survival of both groups was analyzed using the Kaplan-Meier method and compared using the log-rank test. Results: The percentage of HBV positive patients had increased after fifteen years from 32.5% to 67.5%. Only two patients (1.8%) in 2013-2014 were diagnosed with HCC during surveillance program. Proportions of Barcelona Clinic Liver Cancer A, B, C, and D in 2013-2014 were 1.8%, 42%, 28.1%, and 28.1%, respectively. There was an increase in the use of potentially curative treatment, such as surgical resection or combination of loco-regional therapies. The one-year survival rate increased from 24.1% in 1998-1999 to 29.4% in 2013-2014, while the median survival decreased from 146 days to 138 days, but the difference was not statistically significant (p=0.913). Conclusions: There was no improvement in the median survival of HCC patients after fifteen years because most continued to present at late stages. There is an urgent need for a nationwide implementation of a hepatitis screening program and HCC surveillance education.

Keywords

Hepatocellular carcinoma;survival;1998-1999;2013-2104;Indonesia

References

  1. 1997. AJCC Cancer Staging Manual, Philadelphia, Lippincott- Raven.
  2. (2012a). EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol, 56, 908-43. https://doi.org/10.1016/j.jhep.2011.12.001
  3. NCI Dictionary of Cancer Terms [Online]. National Cancer Institute.
  4. 2012b. [Guidelines on Viral Hepatitis Control], Jakarta, Directorate General of Disease Control and Health Restructuring Ministry of Health, Republic of Indonesia [Article in Indonesian].
  5. Davila JA, Henderson L, Kramer JR, et al (2011). Utilization of surveillance for hepatocellular carcinoma among hepatitis C virus-infected veterans in the United States. Ann Intern Med, 154, 85-93. https://doi.org/10.7326/0003-4819-154-2-201101180-00006
  6. Davila JA, Morgan RO, Richardson PA, et al (2010). Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States. Hepatol, 52, 132-41. https://doi.org/10.1002/hep.23615
  7. El-Serag HB, Davila JA, Petersen NJ, et al (2003). The continuing increase in the incidence of hepatocellular carcinoma in the United States: an update. Ann Intern Med, 139, 817-23. https://doi.org/10.7326/0003-4819-139-10-200311180-00009
  8. Hiotis SP, Rahbari NN, Villanueva GA, et al (2012). Hepatitis B vs. hepatitis C infection on viral hepatitis-associated hepatocellular carcinoma. BMC Gastroenterol, 12, 64. https://doi.org/10.1186/1471-230X-12-64
  9. Hucke F, Sieghart W, Schoniger-Hekele M, et al (2011). Clinical characteristics of patients with hepatocellular carcinoma in Austria - is there a need for a structured screening program? Wien Klin Wochenschr, 123, 542-51. https://doi.org/10.1007/s00508-011-0033-9
  10. Johnson PJ, Berhane S, Kagebayashi C, et al (2015). Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol, 33, 550-8. https://doi.org/10.1200/JCO.2014.57.9151
  11. Kudo M (2012). Japan's Successful Model of Nationwide Hepatocellular Carcinoma Surveillance Highlighting the Urgent Need for Global Surveillance. Liver Cancer, 1, 141-3. https://doi.org/10.1159/000342749
  12. Kuo YH, Lu SN, Chen CL, et al (2010). Hepatocellular carcinoma surveillance and appropriate treatment options improve survival for patients with liver cirrhosis. Eur J Cancer, 46, 744-51. https://doi.org/10.1016/j.ejca.2009.12.018
  13. Lin CS, Chang CS, Yang SS, et al (2008). Retrospective evaluation of serum markers APRI and AST/ALT for assessing liver fibrosis and cirrhosis in chronic hepatitis B and C patients with hepatocellular carcinoma. Intern Med, 47, 569-75. https://doi.org/10.2169/internalmedicine.47.0595
  14. Llovet JM, Bru C, Bruix J (1999). Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis, 19, 329-38. https://doi.org/10.1055/s-2007-1007122
  15. Lucas ZDF, Pangan CP, Patal PC, et al (2009). The clinical profile of hepatocellular carcinoma patients at the Philippine General Hospital. Phil J Internal Med, 47, 1-9.
  16. 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. https://doi.org/10.7314/APJCP.2013.14.11.6955
  17. Omata M, Lesmana L, Tateishi R, et al (2010). Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol International, 4, 439-74. https://doi.org/10.1007/s12072-010-9165-7
  18. Rosa I, Denis J, Renard P, et al (2010). A French multicentric longitudinal descriptive study of hepatocellular carcinoma management (The Changh Cohort): preliminary results. J Hepatol, 52, S231-2.
  19. Santi V, Buccione D, Di Micoli A, et al (2012). The changing scenario of hepatocellular carcinoma over the last two decades in Italy. J Hepatol, 56, 397-405. https://doi.org/10.1002/hep.25835
  20. Singal AG, Volk ML, Rakoski MO, et al (2011). Patient involvement in healthcare is associated with higher rates of surveillance for hepatocellular carcinoma. J Clin Gastroenterol, 45, 727-32. https://doi.org/10.1097/MCG.0b013e31820989d3
  21. Singal AG, Yopp A, C SS, et al (2012). Utilization of hepatocellular carcinoma surveillance among American patients: a systematic review. J Gen Intern Med, 27, 861-7. https://doi.org/10.1007/s11606-011-1952-x
  22. Sithinamsuwan P, Piratvisuth T, Tanomkiat W, et al (2000). Review of 336 patients with hepatocellular carcinoma at Songklanagarind Hospital. World J Gastroenterol, 6, 339-43. https://doi.org/10.3748/wjg.v6.i3.339
  23. Somboon K, Siramolpiwat S, Vilaichone RK (2014). Epidemiology and survival of hepatocellular carcinoma in the central region of Thailand. Asian Pac J Cancer Prev, 15, 3567-70. https://doi.org/10.7314/APJCP.2014.15.8.3567
  24. Sulaiman HA, Julitasari, Sie A, et al (1995). Prevalence of hepatitis B and C viruses in healthy Indonesian blood donors. Trans R Soc Trop Med Hyg, 89, 167-70. https://doi.org/10.1016/0035-9203(95)90480-8