2017, Number 2
<< Back Next >>
Ann Hepatol 2017; 16 (2)
Practical Considerations of Real Life of Hepatocellular Carcinoma in a Tertiary Center of Brazil
Almeida-Carvalho SR, Gomes-Ferraz ML, Loureiro-Matos CA, Benedito-Silva AE, Carvalho-Filho RJ, Renato-Perez R, Miziara-Gonzalez A, Salzedas-Netto AA, Szejnfeld D, D’Ippolito G, Pereira-Lanzoni V, Souza-Silva IS
Language: English
References: 29
Page: 255-262
PDF size: 210.79 Kb.
ABSTRACT
Background. Hepatocellular carcinoma (HCC) is the most common malignancy that develops in cirrhotic livers. Its clinical and epidemiological characteristics and mortality rates vary according to geographical region. The objective of this study was to evaluate the
clinical profile, epidemiological characteristics, laboratory parameters, treatment and survival of patients with HCC.
Material and
methods. Patients with HCC seen between 2000 and 2012 were studied. The Kaplan-Meier method was used for survival analysis
according to variables in question.
Results. The study included 247 patients with a mean age of 60 ± 10 years. There was a predominance
of males (74%). The main etiologies of HCC were HCV infection (55%), excessive alcohol consumption (12%), and HBV
infection (8%). Liver cirrhosis was present in 92% of cases. The mean tumor number and diameter were 2 and 5 cm, respectively.
Patients meeting the Milan criteria corresponded to 43% of the sample. Liver transplantation was performed in 22.4% of patients of
the Milan subset and in 10% of the whole sample. The overall mean survival was 60 months, with a 1-, 3- and 5-year survival probability
of 74%, 40% and 29%, respectively. Lower survival was observed among patients with alcoholic etiology. Survival was higher
among patients submitted to liver transplantation (P ‹ 0.001), TACE (P ‹ 0.001), or any kind of treatment (P ‹ 0.001). However, no
difference was found for surgical resection (P = 0.1) or sorafenib (P = 0.1).
Conclusion. Patients with HCC were mainly older men
diagnosed at an advanced stage. Treatment was associated with better overall survival, but few patients survived to be treated.
REFERENCES
IARC (International Agency for Research on Cancer), GLOBOCAN 2012. (; 2012 [accessed 05.09.14])
CDC - Centers for Disease Control and Prevention. Hepatocellular Carcinoma - United States 2001-2006 2010; 59: 517-20.
Colombo M, Franchis R, Ninno ED, Sangiovanni A, Fazio CD, Tommasini M, Donato MF, et al. Hepatocellular carcinoma in Italian patients with cirrhosis. N Engl J Med 1991; 325: 675-80.
Okuda H. Hepatocellular carcinoma development in cirrhosis. Best Pract Res Clin Gastroenterol 2007; 21: 161-73.
Davila JA, Morgan RO, Shaib Y, McGlynn KA, EL-Serag HB. Hepatitis C infection and the increasing incidence of hepatocellular carcinoma: A Population-Based Study. Gastroenterology 2004; 127: 1372-80.
Ferenci P, Fried M, Labrecque D, Bruix J, Sherman M, Omata M, Heathcote J. et al. Hepatocellular Carcinoma (HCC): A Global Perspective. J Clin Gastroenterol 2010; 44: 239-45.
Carrilho FJ, Kikuchi L, Branco F, Gonçalves CS, Mattos AA, Brazilian HCC Study Group. Clinical and epidemiological aspects of hepatocellular carcinoma in Brazil. Clinics 2010; 65: 1285-90.
Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F. et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334: 693-9.
Forner A, Josep ML, Bruix J. Hepatocellular carcinoma. Lancet 2012; 379: 1245-55.
Bosch FX, Ribes J, Cléries R, Díaz M. Epidemiology of Hepatocellular Carcinoma. Clin Liver Dis 2005; 9: 191-211.
Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 2003; 362: 1907-17.
Bucci L, Garuti F, Camelli V, Lenzi B, Farinati F, Giannini EG, Ciccarese F, et al. Comparison between alcohol- and hepatitis C virus-related hepatocellular carcinoma: clinical presentation, treatment and outcome. Aliment Pharmacol Ther 2016; 43: 385-99.
Somboon K, Siramolpiwat S, Vilaichone RK. Epidemiology and Survival of Hepatocellular Carcinoma in the Central Region of Thailand. Asian Pac J Cancer Prev 2014; 15: 3567-70.
Cheung TK, Lai CL, Wong BCY, Fung J, Yuen MF. Clinical features, biochemical parameters, and virological profiles of patients with hepatocellular carcinoma in Hong Kong. Aliment Pharmacol Ther 2006; 24: 573-83.
Kitisin K, Packiam V, Steel J, Humar A, Gamblin TC, Geller DA, Marsh JW, et al. Presentation and outcomes of hepatocellular carcinoma patients at a western centre. HPB (Oxford) 2011; 13: 712-22.
Kneuertz PJ, Demirjian A, Firoozmand ADA, Villalobos CC, Bhagat N, Herman J, Cameron A, et al. Diffuse Infiltrative Hepatocellular Carcinoma: assessment of presentation, treatment, and outcomes. Ann Surg Oncol 2012; 19: 2897-907.
Sherman M. Hepatocellular carcinoma: epidemiology, surveillance, and diagnosis. Semin Liver Dis 2010; 30: 3-16.
Trevisani F, D’Intino PE, Morselli-Labate AM, Mazzella G, Accogli E, Caraceni P, De Notariis S, et al. Serum alpha-fetoprotein for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: influence of HBsAg and anti-HCV status. J Hepatol 2001; 34: 570-5.
Marrero JA, Feng Z, Wang Y, Nguyen MH, Befeler AS, Roberts LR, Reddy KR, et al. AlfaFetoprotein, DesCarboxyprothrombin, and Lectin-Bound. AlfaFetoprotein in Early Hepatocellular Carcinoma. Gastroenterology 2009; 137: 110-18.
Paul SB, Chalamalasetty SB, Vishnubhatla S, Madan K, Gamanagatti SR, Batra Y, Gupta SD, et al. Clinical Profile, Etiology and Therapeutic Outcome in 324 Hepatocellular Carcinoma Patients at a Tertiary Care Center in India. Oncology 2009; 77: 162-71.
Kumar R, Saraswat MK, Sharma BC, Sakhuja P, Sarin SK. Characteristics of hepatocellular carcinoma in India: a retrospective analysis of 191 cases. Q J Med 2008; 101: 479-85.
Addario L, Tritto G, Cavaglia E, Amodio F, Giannelli E, Di Costanzo GG. Preserved liver function, portal thrombosis and absence of oesophageal varices are risk factors for metas tasis of hepatocellular carcinoma. Digestive and Liver Disease 2011; 43: 319-24.
Yang D, Hanna DL, Usher J, LoCoco J, Chaudhari P, Lenz HJ, Setiawan VW, et al. Impact of sex on the survival of patients with hepatocellular carcinoma: A Surveillance, Epidemiology, and End Results analysis. Cancer 2014; 120: 3707-16.
Parikh ND, Waljee AK, Singal AG. Downstaging hepatocellular carcinoma: A systematic review and pooled analysis. Liver Transpl 2015; 21: 1142-52.
Graziadei IW, Sandmueller H, Waldenberger P, Koenigsrainer A, Nachbaur K, Jaschke W, Margreiter R, et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. Liver Transpl 2003; 9: 557-63.
Tsochatzis E, Garcovich M, Marelli L, Papastergiou V, Fatourou E, Rodriguez-Peralvarez ML, Germani G, et al. Transarterial embolization as neoadjuvant therapy pretransplantation in patients with hepatocelular carcinoma. Liver Int 2013; 33: 944-9.
Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, Oliveira AG, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008; 359: 378-90.
Chang YS, Adnane J, Trail PA, Levy J, Henderson A, Xue D, Bortolon E, et al. Sorafenib (BAY 43-9006) inhibits tumor growth and vascularization and induces tumor apoptosis and hypoxia in RCC xenograft models. Cancer chemother pharmacol 2007; 59: 561-74.
Sanyal A, Poklepovic A, Moyneur E, Barghout V. Populationbased risk factors and resource utilization for HCC: US perspective. Curr Med Res Opin 2010; 26: 2183-91.