Changes in Presentation, Treatment, and Survival of Patients with Hepatocellular Carcinoma in Damietta, Egypt, 2007–2019: A Retrospective Monocentric Cohort Study

Abstract

Introduction We aimed to assess temporal changes in the presentation and survival of patients with hepatocellular carcinoma (HCC) in the northern Egypt region, one of the regions reporting the highest incidence of the disease globally. Methods We conducted a monocentric retrospective study. Patients presenting at the Damietta Oncology referral center between 2007 and 2019 with a diagnosed HCC were eligible. Individual, clinical and tumor characteristics at HCC diagnosis, including the Barcelona Clinic Liver Cancer (BCLC) staging, were retrieved from medical files and patients’ final vital status was ascertained by combining various data sources. Patients were divided into 2 groups based on diagnosis period: pre- and post-2014. Survival was analysed based on Kaplan–Meier curves and differences in restricted mean survival time (RMST). Results Data from 5097 patients (among 5210 eligible, 97.8%) were analyzed. We observed a significant trend toward HCC diagnosed at earlier stage in the post- vs pre-2014 period (BCLC stage 0/A or B: 37.2% vs 27.1%, p<10 −3 ). Overall patient’s survival after the HCC diagnosis was poor, with a median of 8.1 months. The BCLC staging system performed well in predicting survival. Despite a trend toward HCC diagnosed at earlier stages, we did not observe a significant improvement in survival over time. Overall, treatments offered in this medical center were in line with international guidelines, and 16.1% of the patients who received a curative treatment had an improved survival (30.7 months in median). However, HCC recurrence was frequent among patients cured for HCC, with a median time to recurrence of 22 months. Discussion Overall survival after HCC diagnosis in Egypt remains poor but is significantly improved by curative therapy. Despite a trend toward earlier diagnosis of HCC, we did not observe a general improvement in survival over time, which remains to be clearly understood.

A Comparison of Presentation, Treatment, and Survival After Hepatocellular Carcinoma of Viral and Non-Viral Etiology in Damietta, Egypt, 2007–2019

“…Recruitment and data collection of this cohort have been previously detailed. 7 Briefly, the cohort included all patients who presented with a diagnosis of HCC between January 1, 2007, and December 31, 2019. HCC diagnosis and presentation data, including the BCLC staging, 10 were extracted from the patient's medical records.…”

“… 6 The high prevalence of HCV in Egypt significantly contributes to the increased HCC indices in the country, accounting for more than 90% of all HCC cases. 7 Moreover, over the past years, the Egyptian National Treatment Programs have conducted large HCV testing actions (screening for more than 65 million population over 8 months) and the linked HCC screening activities among those infected with HCV, especially cirrhotic patients. 8 , 9 These efforts have led to a trend toward HCC diagnosed at earlier stage.…”

“… 8 , 9 These efforts have led to a trend toward HCC diagnosed at earlier stage. 7 However, whether these activities primarily targeted against HCV have impacted differently viral versus non-viral HCC etiology is unknown.…”

Multidisciplinary consensus recommendations for management of hepatocellular carcinoma in Middle East and North Africa region

“…The BCLC algorithm is followed for the treatment of patients with HCC in the MENA region 7,79,80 . Surgical resection and liver transplantation are recommended for patients with early‐stage HCC and are the first‐line treatment options for BCLC Stage 0 and A. Ablative techniques, including percutaneous ethanol injection (PEI), microwave ablation (MWA) or radiofrequency ablation (RFA), catheter‐directed TACE or radio‐embolization (TARE) are often resorted to next 81,82 .…”

“…7,79,80 Surgical resection and liver transplantation are recommended for patients with early-stage HCC and are the first-line treatment options for BCLC Stage 0 and A. Ablative techniques, including percutaneous ethanol injection (PEI), microwave ablation (MWA) or radiofrequency ablation (RFA), catheter-directed TACE or radio-embolization (TARE) are often resorted to next. 81,82 Although PEI is inexpensive and safe with low mortality and morbidity, it has been largely replaced by MWA and RFA over the past decade.…”