TITLE:
Hepatocellular Carcinoma: Risk Factors, Diagnosis, Staging and Treatment in a Referral Centre
AUTHORS:
Raphael Raphe, Willian J. Duca, Paulo C. Arroyo Jr., Rita C. da Silva, Renato F. da Silva
KEYWORDS:
Hepatocellular Carcinoma; Epidemiology; Risk Factors; Liver Cancer; Hepatitis; Alcohol
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.4 No.2A,
February
28,
2013
ABSTRACT:
Introduction: Hepatocellular carcinoma is the most common primary neoplasm of the liver and a significant cause of mortality in patients with cirrhosis. A retrospective cross-sectional study was performed to analyze epidemiological aspects related to risk factors, diagnosis, staging and first-line treatment in a closed population. Methods: The medical records of patients seen between November 1998 and May 2011 were revisited. Results: Of the 272 patients included in this study, 229 (84.2%) were male and the average age was 57.1 years (standard deviation 10.9 years). The most common etiology was hepatitis C virus infection in 145 (55.1%) patients, with this being the single cause in 88 (33.4%) patients. The largest masses ranged from 6 mm to 260 mm in diameter with a mean of 61.4 mm (standard deviation 41.5 mm). Only one mass was found in 145 (64.2%) cases, two masses in 26 (11.5%), three masses in 9 (4%) and 46 patients (20.3%) had multifocal disease. Early stage disease was diagnosed in 47 patients (22.0%), advanced stage in 65 (30.4%) and terminal stage in 32 (14.9%). Hepatocellular carcinoma was found by chance in 11%. Diagnosis was by means of imaging in 175 (68.1%) cases. The level of alpha-fetoprotein was measured in 209 patients, with 29.2% having levels lower than 20 ng/mL and 34.9% having levels above 400 ng/mL. Specific treatment was administered in 236 patients (86.8%) with hepatic chemoembolization in 127 (46.7%) and liver transplantation in 72 (26.5%); of these 33 (45.8%) received hepatic chemoembolization as a bridge to transplantation. Thirty-four patients (12.5%) received only supportive therapy. Conclusions: Patients are chiefly male and disease involvement generally occurs in the 5th decade of life. Cirrhosis was present in most patients and hepatitis C virus infection was the commonest etiologic agent. Only one imaging examination was required for diagnosis in most patients. The measurement of alpha-fetoprotein levels did not prove to be a good tool in the diagnosis of hepatocellular carcinoma. Intermediate, advanced and terminal stages predominated compared to early stages. Treatment was based on non-curative therapies.