Clinical Characteristics of Patients with Hepatocellular Carcinoma in a Middle Eastern Population

Abstract

BackgroundHepatocellular carcinoma (HCC) is one of the leading causes of death in Saudi male patients. Local clinical and demographic data of this disease are scarce.ObjectivesWe sought to describe the clinical characteristics and outcomes of patients from two tertiary care centers in Saudi Arabia.Patients and MethodsData were collected for all patients diagnosed to have hepatocellular carcinoma between June 2003 and July 2008 who had been registered in a special research database (the Saudi Observatory Liver Disease Registry (SOLID)). Data were extracted from SOLID for clinical, biochemical, radiologic parameters and outcome.ResultsData was available for 363 patients, the mean age of diagnosis was 66 years, 74% of patients were males, and Hepatitis C was the underlying cause of liver disease in 48%, while Hepatitis B in 29%. Most of the patients were diagnosed at an advanced stage, 53 % of patients had a CLIP score of 4 to 6 (advanced stage), 55% had large multi-nodular tumors and 16% had vascular invasion or extra-hepatic spread at the time of diagnosis. Most of the patients had decompensated cirrhosis; with child-pogh score B in 44% and C in 26% with presence of portal hypertension in 55%. Forty eight percent died during the study period. Predictors of poor survival in the univariate analysis were; presence of portal vein thrombosis (P = 0.03), portal hypertension (P < 0.0001), presence of ascites (P = 0.022), hepatic encephalopathy (P < 0.0001), advanced child-pough score (P < 0.0001), bilirubin > 22 (P < 0.0001) and INR > 1.2 (P = 0.02). On multivariate analysis, only the presence of portal hypertension, bilirubin > 22 and severe hepatic encephalopathy were significant with adjusted hazard ratio of 1.6 (95% CI; 1.04-2.47), 1.76 (95% CI; 1.12-2.8), and 3.18 (95% CI; 1.42-7.14) respectively.ConclusionsThe data from this cohort indicates that most of patients diagnosed with HCC present at late tumor and liver disease stages, when prognosis is usually dismal. Regular cancer surveillance in cirrhotic patients might change the outcomes. Further studies with results of treatment outcomes in this community are needed.

Clinical characteristics analysis of 1180 patients with hepatocellular carcinoma secondary to hepatitis B, hepatitis C and alcoholic liver disease

“…In this study, in HCC patients aged 41‐60 years old, there were 480 (83.92%) males and 92 (16.08%) females, and in HCC patients ≥61 years old, there were 435 (72.62%) males and 164 (27.38%) females. This study revealed that HCC was more prevalent in males, which is in agreement with previous studies, as well as other local and regional studies …”

“…This study revealed that HCC was more prevalent in males, which is in agreement with previous studies, 16,17 as well as other local and regional studies. 18,19 In addition, the finding that females were significantly older than males might also refect a course in disease progression. Previous studies have shown that the liver fibrosis status of women changes with age, which may be due to changes in the reproductive status, 20 Therefore, less treatment measures will affect the prognosis of patients.…”

Causes and Stages of Hepatocellular Carcinoma at Patient Presentation at a Tertiary Medical Center in Western Saudi Arabia

“…This implementation is expected to result in a significant drop in HBV-related HCC cases in Saud Arabia. Similarly, chronic hepatitis C (CHC)-related liver cirrhosis and HCC are also frequently reported in Saudi Arabia [9]- [11]. The presentation of HCC can be variable, ranging from small focal liver lesions that could be detected during routine radiological screenings of cirrhotic patients to advanced disease with severe local invasion or even distant metastasis [3] [12] [13].…”

Epidemiology and viral risk factors for hepatocellular carcinoma in the Eastern Mediterranean countries

“…China has the highest incidence of HCC in the world, accounting for more than 40% of all HCC cases and 55% of liver cancer deaths [3,4] . Southern European countries have an intermediateincidence (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) cases per 100,000 population/year); while North America, South America, Northern Europe, and parts of Middle East have low-incidence rates (< 5 cases per 100,000 population/year) [3][4][5] . The incidence in Asian countries tends to decline in the past 2 decades whilst it increased in United States and Canada because of high rate of chronic hepatitis C virus (HCV)-related cirrhosis, nonalcoholic fatty liver disease and immigrants from HBV endemic regions [4] .…”

“…The median age of diagnosis is 66 years [12] . The results of a tertiary center in Saudi Arabia showed that most of the patients diagnosed with HCC presented at late tumor stages with advanced liver disease and had poor prognosis with an average of 33-month survival [12] . This prompts the implementation of HCC surveillance strategies in this geographic region.…”