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Published on: September 30, 2021
Profile of patients with hepatocellular carcinoma: An experience from a tertiary care center in India
Balaji Musunuri1, Shiran Shetty2, Ganesh Bhat2
1Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576 104, India. balaji.musunuri@manipal.edu.
Insights
Hepatocellular carcinoma (HCC) is rising globally, with non-alcoholic fatty liver disease (NAFLD) becoming a leading cause. Most HCC cases are diagnosed late, highlighting challenges in early detection and management of this growing cancer burden.
Area of Science:
- Hepatology
- Oncology
- Gastroenterology
Background:
- Hepatocellular carcinoma (HCC) incidence and mortality are increasing worldwide, posing a significant global health challenge.
- HCC is the third leading cause of cancer-related death globally.
Purpose of the Study:
- To analyze the clinical, etiological, radiological, and cytohistological characteristics of HCC patients.
- To evaluate the therapeutic approaches and outcomes in a tertiary care setting in India.
Main Methods:
- Observational study conducted over 3 years at a tertiary care center in India.
- Inclusion of 339 patients diagnosed with HCC.
- Systematic recording and analysis of clinical, etiological, radiological, cytohistological data, and therapy offered.
Main Results:
- Non-alcoholic fatty liver disease (NAFLD) is the most common etiology (51%), surpassing Hepatitis B (17.4%) and C (5.8%).
- Most patients presented with advanced disease (BCLC stages C and D: 62.4%) and signs of hepatic decompensation like ascites (57.2%).
- Late diagnosis was common, with only 26.6% of cirrhotic HCC patients detected during surveillance.
Conclusions:
- NAFLD is emerging as the predominant cause of HCC, shifting the etiological landscape.
- Despite diagnostic advancements, the majority of HCC cases are diagnosed at advanced stages, underscoring the need for improved early detection strategies.
Background:
The prevalence of hepatocellular carcinoma (HCC) is increasing worldwide and it is now the third most common cause of cancer-related death. HCC is becoming a major health burden with steadily increasing incidence globally.
Methods:
This is an observational study over a 3-year period in a tertiary care center in India. Three hundred and thirty-nine patients diagnosed to have HCC were included in this study. Patients' clinical, etiological, radiological and cytohistological data and therapy offered were recorded and analyzed.
Results:
Cirrhosis of the liver was seen in 73.2% of the patients. 16.8% of patients were asymptomatic at the time of presentation. Ascites (57.2%) and jaundice (22.4%) were the most common signs of hepatic decompensation. The most common etiology of HCC was cryptogenic/non-alcoholic fatty liver disease (NAFLD) in 51% of the patients, while hepatitis B and C were seen in 17.4% and 5.8% of the patients, respectively. Advanced and end-stage disease with Barcelona Clinic Liver Cancer (BCLC) stages C and D were seen in 62.4% of patients. 56.6% had Albumin-bilirubin (ALBI) score of 2, while 62.8% had Okuda stage II disease. High alpha-fetoprotein (AFP) levels (>400 ng/mL) were seen in 48.9% of patients. Macrovascular invasion and metastases were seen in 45.9% and 22.2% of the patients, respectively. 17.6% of patients had evidence of tumor thrombus. 14.5% of biopsy specimens showed associated steatosis/steatohepatitis along with confirmation of HCC. Only 26.6% of the cirrhotic HCC patients were diagnosed during surveillance.
Conclusions:
HCC due to unknown cause/NAFLD appears to be overtaking hepatitis B as the commonest cause for HCC. Despite the advances in diagnostic methods and surveillance, most cases of HCC tend to be diagnosed at advanced stages.
