Inspecting Management Strategies of Hepatocellular Carcinoma in a Tertiary Centre in Western Rajasthan (original) (raw)

Clinical Profile and Treatment of Hepatocellular Carcinoma: A Single-Center Experience

South Asian Journal of Cancer, 2021

Background Very few centers in Pakistan have all established treatments for hepatocellular carcinoma (HCC) available under one roof. With a dedicated hepato-pancreato-biliary surgery and liver transplant unit, we have gathered one of the largest data on HCC in our population. Aims The objective of the current study was to assess the clinical spectrum of HCC in Pakistani patients. Settings and Design This retrospective review of patients diagnosed with HCC was conducted between 2011 and 2016. Materials and Methods Patients were allocated to treatment groups based on the Barcelona clinic liver cancer (BCLC) staging algorithm and our local guidelines. The treatment options were grouped as curative (radiofrequency ablation [RFA], percutaneous ethanol injection [PEI], liver resection, and liver transplantation), palliative (transarterial chemoembolization [TACE]/sorafenib), and the best supportive care (BSC). Statistical Analysis Kaplan–Meier curves were used for the statistical analysis...

Hepatocellular Carcinoma (HCC): Epidemiology, Risk Factors, and Survival

Background: HCC is an aggressive tumour with unpredictable outcome. It is fourth most common cause of cancers in India. However, information on HCC is inadequate in India.Therefore purpose of study is to determine overall survival for patients diagnosed with hepatocellular carcinoma (HCC) and association between various predictive factors and survival. Results: The median overall survival (OS) was 5 months ranging from 0-13 months. Majority of patients were in advance stage (III/IV). All patient died by 13 months. None of the possible predictive factors were found to be significantly associated with survival (P > 0.05) by univariate analysis. However age < 59 yrs, male gender, KPS ≤ 60, AFP ≥ 400, cirrhosis, multifocality, tumour size > 10 cm, advance stage (IIIB/IV), child pugh score B/C, CLIP score ≥ 4 and raised bilirubin level had poorer survival compared to other predictive factors. Median survival was better in patient treated with TACE followed by sorafenib + palliat...

Hepatocellular carcinoma: From clinical practice to evidence-based treatment protocols

World Journal of Hepatology, 2015

In response to the hepatocellular carcinoma (HCC) burden marked differences between countries are reflected in providing disparate quality of healthcare considering screening and surveillance programs; available treatment modalities and drugs; reimbursement of specific treatment options by the statefunded health insurance. Since the number of new HCC cases being diagnosed each year is nearly equal to the number of deaths from this cancer it is clear that the international scientific community and healthcare systems worldwide have no efficient answer to this problem. International consensus on the use of any given staging model is lacking. High-quality trials with better patients' stratification are mandatory. This review article reflects the perspective of liver surgeons working in a developing country.

Management of hepatocellular carcinoma: a study on 240 patients in a single referral center

Scripta Scientifica Medica

INTRODUCTION: Hepatocellular carcinoma (HCC) is а leading cause of cancer-related death globally. Our study aimed to provide an understanding of the risk factors, pattern and management of HCC in a real-life practice. MATERIALS AND METHODS: Two hundred and forty consecutive patients with HCC were evaluated for an 11-year period (from 2006 to 2016). During the last 5 years the patients were followed up prospectively from the time of the diagnosis to their death. RESULTS: A hundred and seventy-two males and 68 females (mean age 66.4±10.3 and 62.4±9.5 years, respectively) were included in the observation. Hepatitis B virus (HBV) infection accounted for 40.4% and hepatitis C virus (HCV) infection-for 25.8% of the aetiology of liver disease. Cirrhosis is a baseline condition in 82%. HCC was found to be a first complication of liver disease in 2/3 of the studied patients. Using Barcelona Clinic Liver Cancer staging system HCC can be categorised as: stage 0 (n=3); stage A (n=32); stage B (n=52); stage C (n=75) and stage D (n=103). Therefore, the prevalence of very early and early HCC was 13%. Radical therapy (resection or ablation) was recommended in 28% of the patients. Importantly, 18 of 55 (32.7%) patients after surgical resection were followed for more than 3 years without tumour relapse. The median survival, based on the main treatment was: 36 months after surgical resection; 24 months after ablation; 10.5 months for patients on Sorafenib; 9.5 months after TACE and only 3 months for palliative care. CONCLUSION: Our study confirms the observed trends in underlying diseases, the heterogeneity of survival and underscores the need of early diagnosis of HCC.

Treatment of hepatocellular carcinoma: beyond international guidelines

Liver International, 2014

Treatment of hepatocellular carcinoma (HCC) is guided by the tumour stage. The Barcelona clinical liver cancer (BCLC) score endorsed by the European Society of the Liver EASL divides patients into five prognostic categories, each with a distinct treatment indication. Hepatic resection, orthotopic liver transplantation and percutaneous local ablation are strongly indicated in accurately selected patients with very early (BCLC 0) and early stage (BCLC A) tumours providing a survival rate of between 50 and 75% at year five. In patients with a large tumour burden such as those with intermediate stage BCLC B, repeated treatments with transarterial chemoembolization (TACE) are advocated with clinical benefits (from 16 to 22 months). Survival may also improve in patients who are in poor condition or who do not respond to TACE and those with an advanced HCC (BCLC C), following oral therapy with the multikinase inhibitor, sorafenib. However, most recommendations are based on uncontrolled studies and expert opinions rather than well-designed controlled trials, and up to one-third of patients do not fit recommendations because of advanced age, the presence of significant comorbidities or a strategic location of the nodule. For these patients, treatment of HCC beyond guidelines is often advocated.

Treatment options in Western hepatocellular carcinoma: a prospective study of 224 patients

Journal of Hepatology, 1998

in the world, the optimal therapeutic strategy is still poorly defined. This is mainly due to geographic differences in HCC which may affect the validity of treatment regimens in differents areas of the world. The aim of the present study was to analyze the natural course of the disease as well as to assess the efficacy of different therapeutical schemes in HCC observed in Ljubljana (Slovenia) and Trieste (Italy), two cities in Western Europe situated close to each other. Methods: During the period from January 1988 to December 1993, 224 consecutive patients (132 in Trieste and 92 in Ljubljana) with HCC were enrolled in the study. Patients were treated with the following 3 schemes: surgery 39 (17.4%), transcatheter chemoembolization (TACE) 116 (51.8%), and no treatment 69 (30.8%). The tumor was classified by Okuda staging and the liver disease by Child-Pugh score. Patients were followed up for 12-60 months, with an average of 40 months. The response rate to TACE and recurrence following surgery were evaluated. Comparative analysis of survival between different treatment groups was performed. Results: The natural course of the disease, and other characteristics of the HCC, showed a typical Western type of tumor. Liver disease was scored as Child A in 58%, Child B in 30% and Child C in 12%, and the H  carcinoma (HCC) is one of the most common malignant tumors in the world (1). The incidence, however, shows large geographic tumor was staged as Okuda I in 52%, Okuda II in 37% and Okuda III in 11%, respectively. Treatment with TACE was followed by an objective response in 27%, with a median survival of 31 months. Surgery was followed by a recurrence rate of 77% within 19.5 months and median survival of 49 months. The overall median survival of nontreated patients was 8 months. Survival in each group of patients differed significantly between all three consecutive stages of Okuda (p∞0.001). In contrast, the differences in survival were significant only between Child A and B (p∞0.02). The differences between Child B and C were not significant. Conclusions: This study emphasizes the importance of staging in the choice of treatment modality and diffusion of HCC in affecting an overall response to treatment and survival. Surgery is highly effective in monofocal HCC of Okuda I and II without cirrhosis. TACE is effective in Okuda I and II and Child A cirrhosis only. The treatment of HCC in Child B cirrhosis needs further studies. In Child C and/or Okuda stage III of HCC, any treatment except pure symptomatic relief is detrimental and should not be used.

Management strategies for hepatocellular carcinoma: old certainties and new realities

Clinical and Experimental Medicine, 2015

Hepatocellular carcinoma (HCC) is a highly prevalent disease ranking among the ten most common cancers worldwide with increasing trend of incidence in most developed countries. The great healthcare costs and economic burden of HCC dictate proper preventive interventions as well as surveillance and screening programs to decrease disease incidence and allow early diagnosis. HCC treatment outcomes are affected by several variables, including liver function, patient's performance status, and tumor stage. In line with the Barcelona Clinic Liver Cancer (BCLC) staging curative treatments, such as surgery or radio-frequency ablation, are indicated in early-stage HCC (BCLC-A), and the noncurative treatments are indicated in intermediate and advanced stages of HCC (BCLC-B, C). Transarterial chemoembolization (TACE) represents the treatment of choice for intermediate-stage HCC with Child-Pugh A cirrhosis, and the long-term survival after liver transplantation is inferior to that of early-stage HCCs. In advanced-stage HCC or when complete necrosis is not achieved or early recurrence after TACE develops, individualized treatments such as systemic treatment or combined radiation therapy are indicated. The increasing knowledge of the genomic landscape of HCC and the development of molecular-targeted therapies is heading toward expanding the armamentarium for HCC management.