Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Survival and Prognostic Factors for Hepatocellular Carcinoma: an Egyptian Multidisciplinary Clinic Experience

  • Abdelaziz, Ashraf Omar (Department Endemic Hepatogastroenterology, National Cancer Institute, Cairo University) ;
  • Elbaz, Tamer Mahmoud (Department Endemic Hepatogastroenterology, National Cancer Institute, Cairo University) ;
  • Shousha, Hend Ibrahim (Department Endemic Hepatogastroenterology, National Cancer Institute, Cairo University) ;
  • Ibrahim, Mostafa Mohamed (Department Endemic Hepatogastroenterology, National Cancer Institute, Cairo University) ;
  • El-Shazli, Mostafa Abdel Rahman (Department General Surgery, National Cancer Institute, Cairo University) ;
  • Abdelmaksoud, Ahmed Hosni (Department Diagnostic and Interventional Radiology, National Cancer Institute, Cairo University) ;
  • Aziz, Omar Abdel (Department Diagnostic and Interventional Radiology, National Cancer Institute, Cairo University) ;
  • Zaki, Hisham Atef (Department Clinical Oncology, National Cancer Institute, Cairo University) ;
  • Elattar, Inas Anwar (Department Biostatistics and Cancer Epidemiology, National Cancer Institute, Cairo University) ;
  • Nabeel, Mohamed Mahmoud (Department Endemic Hepatogastroenterology, National Cancer Institute, Cairo University)
  • Published : 2014.05.15
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Abstract

Background: Hepatocellular carcinoma (HCC) is a dismal tumor with a high incidence, prevalence and poor prognosis and survival. Management of HCC necessitates multidisciplinary clinics due to the wide heterogeneity in its presentation, different therapeutic options, variable biologic behavior and background presence of chronic liver disease. We studied the different prognostic factors that affected survival of our patients to improve future HCC management and patient survival. Materials and Methods: This study is performed in a specialized multidisciplinary clinic for HCC in Kasr El Eini Hospital, Cairo University, Egypt. We retrospectively analyzed the different patient and tumor characteristics and the primary mode of management applied to our patients. Further analysis was performed using univariate and multivariate statistics. Results: During the period February 2009 till February 2013, 290 HCC patients presented to our multidisciplinary clinic. They were predominantly males and the mean age was $56.5{\pm}7.7years$. All cases developed HCC on top of cirrhosis that was mainly due to HCV (71%). Most of our patients were Child-Pugh A (50%) or B (36.9%) and commonly presented with small single lesions. Transarterial chemoembolization was the most common line of treatment used (32.4%). The overall survival was 79.9% at 6 months, 54.5% at 1 year and 22.4% at 2 years. Serum bilirubin, site of the tumor and type of treatment were the significant independent prognostic factors for survival. Conclusions: Our main prognostic variables are the bilirubin level, the bilobar hepatic affection and the application of specific treatment (either curative or palliative). Multidisciplinary clinics enhance better HCC management.

Keywords

References

  1. Abdel-Hamid NM, Nazmy MH, Mahmoud AW, Fawzy MA, Youssof M (2011). A survey on herbal management of hepatocellular carcinoma. World J Hepatol. 3, 175-83. https://doi.org/10.4254/wjh.v3.i7.175
  2. Bruix J, Sherman M (2005) Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology, 42, 1208-36. https://doi.org/10.1002/hep.20933
  3. Bruix J, Sherman M (2011). American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology, 53, 1020-2. https://doi.org/10.1002/hep.24199
  4. Bruix J, Sherman M, Llovet JM (2001). EASL Panel of Experts on HCC. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol, 35, 421-30. https://doi.org/10.1016/S0168-8278(01)00130-1
  5. Della Corte C, Colombo M (2012). Surveillance for hepatocellular carcinoma. Semin Oncol, 39, 384-98. https://doi.org/10.1053/j.seminoncol.2012.05.002
  6. Dogan E, Yalcin S, Koca D, Olmez A (2012). Clinicopathological characteristics of hepatocellular carcinoma in Turkey. Asian Pac J Cancer Prev, 13, 2985-90. https://doi.org/10.7314/APJCP.2012.13.6.2985
  7. Egyptian Ministry of Health. Egyptian Ministry of Health Annual Report (2007). Available from: http://www.mohp.gov.eg/Main.asp
  8. Elbaz T, Kassas M, Esmat G (2013). Management of Hepatocellular Carcinoma: Updated Review. J Cancer Therapy, 4, 536-45. https://doi.org/10.4236/jct.2013.42067
  9. El-Serag HB, Siegel AB, Davila JA, et al (2006). Treatment and outcomes of treating of hepatocellular carcinoma among Medicare recipients in the United States: a population-based study. J Hepatol, 44, 158-66. https://doi.org/10.1016/j.jhep.2005.10.002
  10. Esmat G, Elbaz T, Kassas M (2013). Hepatocellular carcinoma in Egypt: An updated status. Liver Cancer: Act today, save your life tomorrow. World Gastroenterology Organisation (WGO). WDHD 2013 Final Publication. www.wgofoundation.org/WDHD-2013-Final-Publication.pdf
  11. Ezzat S, Abdel-Hamid M, Eissa SA, et al (2005). Associations of pesticides, HCV, HBV, and hepatocellular carcinoma in Egypt. Int J Hyg Environ Health, 208, 329-39. https://doi.org/10.1016/j.ijheh.2005.04.003
  12. Forner A, Llovet JM, Bruix J (2012). Hepatocellular carcinoma. Lancet, 379, 1245-55. https://doi.org/10.1016/S0140-6736(11)61347-0
  13. Freedman LS, Edwards BK, Ries LAG (2006). Cancer incidence in four member countries (Cyprus, Egypt, Israel, and Jordan) of the middle east cancer consortium (MECC) compared with US SEER. Bethesda: National Cancer Institute; Available in: http://seer.cancer.gov/publications/mecc/mecc_monograph.pdf
  14. Grieco A, Pompili M, Caminiti G, et al (2005). Prognostic factors for survival in patients with earlyintermediate hepatocellular carcinoma undergoing non-surgical therapy: comparison of Okuda, CLIP, and BCLC staging systems in a single Italian centre. Gut, 54, 411-8. https://doi.org/10.1136/gut.2004.048124
  15. Guy J, Kelley RK, Roberts J, Kerlan R, Yao F, Terrault N (2012). Multidisciplinary management of hepatocellular carcinoma. Clin Gastroenterol Hepatol, 10, 354-62. https://doi.org/10.1016/j.cgh.2011.11.008
  16. Kaseb AO, Abaza YM, Roses RE (2013). Multidisciplinary management of hepatocellular carcinoma. Recent Results Cancer Res, 190, 247-59. https://doi.org/10.1007/978-3-642-16037-0_16
  17. Khattab MA, Eslam M, Sharwae MA, Hamdy L (2010) Seroprevalence of hepatitis C and B among blood donors in Egypt: Minya Governorate, 2000-2008. Am J Infect Control, 38, 640-1. https://doi.org/10.1016/j.ajic.2009.12.016
  18. Kirchner G, Kirovski G, Hebestreit A, et al (2010). Epidemiology and survival of patients with hepatocellular carcinoma in Southern Germany. Int J Clin Exp Med, 3, 169-79.
  19. Lee SS, Shin HS, Kim HJ, et al (2012). Analysis of prognostic factors and 5-year survival rate in patients with hepatocellular carcinoma: a single-center experience. Korean J Hepatol, 18, 48-55. https://doi.org/10.3350/kjhep.2012.18.1.48
  20. Lerose R, Molinari R, Rocchi E, Manenti F, Villa E (2001). Prognostic features and survival of hepatocellular carcinoma in Italy: impact of stage of disease. Eur J Cancer, 37, 239-45. https://doi.org/10.1016/S0959-8049(00)00354-3
  21. 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
  22. Llovet JM, Bustamante J, Castells A, et al (1999). Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology, 29, 62-7. https://doi.org/10.1002/hep.510290145
  23. National Cancer Registry of Egypt (2010). Magnitude of hepatocellular carcinoma in Egypt. Available from: http://www.nci.cu.edu.eg/
  24. 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
  25. Op den Winkel M, Nagel D, Sappl J, et al (2012). Prognosis of patients with hepatocellular carcinoma. Validation and ranking of established staging-systems in a large western HCC-cohort. PLoS One, 7, 45066. https://doi.org/10.1371/journal.pone.0045066
  26. Park JW (2002). National policy of early detection in hepatocellular carcinoma. Korean J Hepatol, 8, 16-9.
  27. Raza SA, Clifford GM, Franceschi S (2007). Worldwide variation in the relative importance of hepatitis B and hepatitis C viruses in hepatocellular carcinoma: a systematic review. Br J Cancer, 96, 1127-34. https://doi.org/10.1038/sj.bjc.6603649
  28. Takayasu K, Arii S, Ikai I, et al (2006). Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology, 131, 461-9. https://doi.org/10.1053/j.gastro.2006.05.021
  29. Tandon P, Garcia-Tsao G (2009). Prognostic indicators in hepatocellular carcinoma: a systematic review of 72 studies. Liver Int, 29, 502-10. https://doi.org/10.1111/j.1478-3231.2008.01957.x
  30. The Egyptian Guidelines for Management of Hepatocellular Carcinoma by Egyptian Society of Liver Cancer. First edition (2011). In: www.egslc.com/content/Guidlines.pdf
  31. World Health Organization (2010). Mortality database. IARC. Available from: http://www-dep.iarc.fr/WHOdb/WHOdb.htm
  32. Yeh C, Chen M, Lee W, Jeng L (2002). Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis: univariate and multivariate analysis. J Surg Oncol, 81, 195-02. https://doi.org/10.1002/jso.10178
  33. Xu J, Liu C, Zhou L, et al (2012). Distinctions between clinicopathological factors and prognosis of alpha-fetoprotein negative and positive hepatocelluar carcinoma patients. Asian Pac J Cancer Prev, 13, 559-62. https://doi.org/10.7314/APJCP.2012.13.2.559
  34. Zekri AR, Hassan ZK, Bahnassy AA, et al (2012). Molecular prognostic profile of Egyptian HCC cases infected with hepatitis C virus. Asian Pac J Cancer Prev, 3, 5433-8. https://doi.org/10.7314/APJCP.2012.13.11.5433

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