Hepatocellular carcinoma: clinicopathological profile and challenges of management in a resource-limited setting

Abstract

BackgroundHepatocellular carcinoma is one of the most common cancers worldwide and its incidence is reported to be increasing in resource-limited countries. There is a paucity of published data regarding hepatocellular carcinoma in Tanzania, and the study area in particular. This study describes the clinicopathological profile of hepatocellular carcinoma in our local setting and highlights the challenging problems in the management of this disease.MethodsThis was a retrospective study of histopathologically confirmed cases of hepatocellular carcinoma seen at Bugando Medical Center between March 2009 and February 2013.ResultsA total of 142 patients (M: F = 2.2: 1) were studied representing 4.6% of all malignancies. The median age of patients was 45 years. Hepatitis B virus infection (66.2%) and heavy alcohol consumption (60.6%) were the most frequently identified risk factors for hepatocellular carcinoma. The majority of patients (88.0%) presented late with advanced stages. HBsAg was positive in 66.2% of the patients and Hepatitis C Virus antibody in 16.9%. Thirteen (9.2%) patients tested positive for HIV infection. Most patients (52.8%) had both right and left lobe involvement. The trabecular pattern (47.9%) was the most frequent histopathological type. None of patients had curative therapy because of the advanced nature of the disease. Coagulopathy (45.7%) was the most common complications. The overall mortality rate was 46.5% and it was significantly associated with comorbidity, HIV positivity, CD4+ count <200 cells/μl, high histological grade, advanced stage of the tumor, presence of distant metastases at the time of diagnosis, and associated complications (P < 0.001). The overall median duration of hospital stay was 14 days. The majority of patients (71.1%) were lost to follow-up at the end of the follow-up period.ConclusionsHepatocellular carcinoma patients in this region are relatively young at diagnosis and the majority of them present late with an advanced stage and high rate of distant metastasis. Lack of awareness of the disease, poor accessibility to healthcare facilities, and lack of screening programs in this region may contribute to advanced disease at the time of diagnosis. There is a need for early detection, adequate treatment, and proper follow-up to improve treatment outcome.

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.…”

Overexpression of osteopontin promotes resistance to cisplatin treatment in HCC

“…Hepatocellular carcinoma (HCC) is one of the most common and serious malignancies worldwide (1,2). Due to its highly aggressiveness and poor prognosis, patients with advanced HCC are not candidates for local/regional surgical resection (3)(4)(5). Cirrhosis of any etiology is a risk factor for HCC, which include infection with hepatitis B virus (HBV) or hepatitis C virus (HCV), alcoholic cirrhosis and exposure to environmental toxins such as aflatoxin (6)(7)(8).…”

The effects of focal adhesion kinase on the motility, proliferation and apoptosis of Caco2 and SMMC-7721 cells

“…Colorectal cancer is accounted as 8 % (n = 608,700) of all cancer deaths worldwide [1], and the third leading cause of cancer-related deaths in the USA [2]. Hepatocellular carcinoma is the third leading cause of cancer deaths worldwide [3] with the prevalence 16-32 times higher in developing countries than in developed countries [4].…”