Clinical Presentation, Risk Factors, and Treatment Modalities of Hepatocellular Carcinoma: A Single Tertiary Care Center Experience

Abstract

Objective. To investigate the risk factors, clinical characteristics, treatment modalities, and outcomes in Saudi patients with HCC and propose points for early detection of the disease. Methods. Patients were stratified according to underlying risk factors for the development of HCC. Barcelona Clinic Liver Cancer (BCLC) was used for cancer staging. Treatment was classified into surgical resection/liver transplantation; locoregional ablation therapy; transarterial embolization; systemic chemotherapy; and best supportive care. Results. A total of 235 patients were included. Males had higher tumor size and incidence of portal vein thrombosis. Viral hepatitis was a risk factor in 75.7%. The most common BCLC stages were B (34.5%) and A (33.6%), and the most common radiological presentation was a single nodule of less than 5 cm. Metastases were present in 13.2%. Overall, 77 patients (32.8%) underwent a potentially curative treatment as the initial therapy. The most commonly utilized treatment modality was chemoembolization with 113 sessions in 71 patients. The overall median survival was 15.97 ± 27.18 months. Conclusion. HCC in Saudi Arabia is associated with high prevalence of HCV. Potentially curative therapies were underutilized in our patients. Cancer stage BCLC-B was the most frequent (34.5%) followed by BCLC-A (33.6%). The overall median survival was shorter than other studies.

The prevalence and associated factors of viral hepatitis and cryptogenic related hepatocellular carcinoma at King Abdulaziz Medical city-Riyadh

“…Most of the patients had a single lesion with 2-5 cm, which in constant with the previous study. 10 Single and large HCC lesions (>5 cm) were significantly more with cryptogenic HCC, which is in keeping with other studies. [22][23][24] However, multiple and small lesions (<2 cm) were noticeably found more in patients with HCV-related HCC.…”

“…26,27 Extra-hepatic metastasis was found only in 18% of the patients, similarly to the previous report. 10 Liver cirrhosis is the most common condition associated with HCC and it was found in 92% of our patients, similarly to other studies. 28,29 Despite the recent decline, HCV is still the leading cause of chronic liver disease.…”

“…13 In our study, the most important risk factor for HCC was HCV, which is consistent with most of the previous studies. [8][9][10] However, cryptogenic HCC was the second common after hepatitis C, which is in contrast to a previously reported local study conducted in the same institute where it found that HBV was the second common after HCV. 10 This decrease in HBV-related HCC could be linked to the increased awareness of both social and clinical practice, better living condition and implantation of vaccination program by Saudi Ministry of Health thirty years ago.…”

“…Male gender represented more than two third of the patients, similar to other local studies. [8][9][10] Physiological differences between males and females can play a role in the pathogenesis of HCC. For instance, estrogen seems to prevent HCC development by inhibiting the production of Interleukin 6 (IL-6) and ultimately protecting the liver cells injury and proliferation.…”

“…In our finding, most of the patients were older with a median age of 67 years, similarly with most of the previous local studies. 9,10,12 This might be related to delayed development of HCC among viral hepatitis, especially in HCV. 13 In our study, the most important risk factor for HCC was HCV, which is consistent with most of the previous studies.…”