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Hepatocellular carcinoma in Karachi
H Qureshi1, S J Zuberi, N A Jafarey
1Pakistan Medical Research Council, Research Centre, Basic Medical Sciences Institute (Pathology), Karachi.
Insights
Hepatocellular carcinoma (HCC) in Karachi is strongly linked to Hepatitis B virus (HBV) infection and aflatoxin exposure. Most patients presented with a mass and pain, and tragically, nearly all died within six months.
Area of Science:
- Hepatology
- Oncology
- Epidemiology
Background:
- Hepatocellular carcinoma (HCC) is a significant global health concern.
- Understanding etiological factors and clinical presentation is crucial for effective management.
- Karachi, Pakistan, presents a unique demographic for studying HCC.
Purpose of the Study:
- To define the clinical presentation of HCC in Karachi.
- To investigate potential etiological factors contributing to HCC occurrence.
- To analyze survival rates and histopathological findings.
Main Methods:
- Retrospective analysis of 366 histologically confirmed HCC cases over 16 years.
- Clinical data collection including demographics, presenting features, and history.
- Laboratory investigations: alpha-Fetoprotein (AFP) levels, Hepatitis B surface antigen (HBsAg), anti-Hepatitis B core (anti-HBc), anti-delta, and aflatoxin contamination assessment.
Main Results:
- Maximum HCC frequency observed in the 51-60 age group (male to female ratio 2.5:1).
- Key presenting features included right hypochondrial mass (85%) and pain (79%).
- High positivity rates for HBsAg (60% by RIA) and anti-HBc (60%), with 41% anti-delta positive.
- Significant association suggested between HCC, HBsAg, and aflatoxin contamination (10-17% in Karachi).
- 73% of HCC cases were trabecular type; 1.2% mortality within 6 months.
Conclusions:
- Hepatitis B virus infection and aflatoxin exposure are likely major contributors to HCC in Karachi.
- Early detection and intervention strategies targeting these factors are warranted.
- The high mortality rate underscores the aggressive nature of HCC and the need for improved outcomes.
Abstract:
The present study defines the clinical presentation and examines possible aetiological factors in the occurrence of hepatocellular carcinoma in Karachi, Pakistan. Histologically proven cases of hepatocellular carcinoma (n = 366) were seen over 16 years. The maximum frequency occurred in the age range 51-60 years (range: 8-98 years), and the male to female ratio was 2.5:1. The place of birth, place of longest stay and various addictions did not have any association with the occurrence of liver carcinoma. Only three cases had a history of liver cancer in their immediate relatives. The main presenting features were right hypochondrial mass (85%) and pain (79%). The liver size did not correlate with the duration of illness. alpha-Fetoprotein titres were more than 200 ng/mL in 62% of cases. Using a reverse passive haemagglutination assay method, HBsAg and anti-HBc positivity were 32% and 60%, respectively. Antigen figures rose to 60% when radio-immunoassay was used; 41% of cases were anti-delta positive (EIA). Aflatoxin contamination varied between 10% and 17% in various localities of Karachi, suggesting an association of liver cancer with HBsAg and aflatoxins. Histopathologically 73% were trabecular, and 2.5% were mixed hepatocholangiocarcinomas. Follow-up was available in 45% of cases. All except two (1.2%) died within 6 months.