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Profile of hepatocellular carcinoma in a tertiary care hospital in Punjab in northern India

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Abstract

Purpose/Aim

Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality in all parts of the world. We analyzed the clinical presentation, etiology, and tumor characteristics of HCC presenting to our hospital.

Methods

All patients diagnosed to have HCC from September 2007 to August 2010 were prospectively enrolled. HCC was diagnosed according to EASL criteria—USG/CT/MRI of the abdomen and/or serum alpha-fetoprotein and/or histology (where indicated). Detailed clinical and laboratory parameters were noted. Barcelona Clinic Liver Cancer (BCLC) staging was done.

Results

One hundred and twenty-eight patients (22 females, mean±SD; age, 49.8 ± 10.2 years) were diagnosed to have HCC. Underlying cirrhosis was present in 99.2 %. Hepatitis C virus infection, alone (21.9 %) or with alcohol (22.9 %) was the most common etiological factor, followed by alcohol alone; 33.6 % of the patients had more than one etiological factor. Most patients (83.5 %) presented with features of decompensated cirrhosis. HCC leading to decompensation of cirrhosis was the first presentation of the liver disease in nearly one third of the cases. Serum alpha-fetoprotein was >200 ng/mL in 67.2 % of the patients, while it was normal in 18.7 % of the patients. The mean±SD size of HCC was 5.3 ± 2.9 cm. HCC was multicentric in 57 %, and portal vein thrombosis was present in 34.4 %. About 66 % of the patients belonged to BCLC stage C or D.

Conclusions

Hepatitis C virus infection was the most common cause of HCC in Punjab. One-third of the patients had multiple etiological factors and almost all had underlying cirrhosis and presented at advanced stage.

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References

  1. Sherman M. Hepatocellular carcinoma: epidemiology, surveillance, and diagnosis. Semin Liver Dis. 2010;30:3–16.

    Article  CAS  PubMed  Google Scholar 

  2. Parkin D, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer. 2001;94:153–6.

    Article  CAS  PubMed  Google Scholar 

  3. Wands JR, Blum HE. Primary hepatocellular carcinoma. N Engl J Med. 1991;325:729–31.

    Article  CAS  PubMed  Google Scholar 

  4. Okuda K, Fujimoto I, Hanai A, Urano Y. Changing incidence of hepatocellular carcinoma in Japan. Cancer Res. 1987;47:4967–72.

    CAS  PubMed  Google Scholar 

  5. Taylor-Robinson SD, Foster GR, Arora S, Hargreaves S, Thomas HC. Increase in primary liver cancer in the UK, 1979–94. Lancet. 1997;350:1142–3.

    Article  CAS  PubMed  Google Scholar 

  6. Deuffic S, Poynard T, Buffat L, Valleron AJ. Trends in primary liver cancer. Lancet. 1998;351:214–5.

    Article  CAS  PubMed  Google Scholar 

  7. Stroffolini T, Andreone P, Andriulli A, et al. Characteristics of hepatocellular carcinoma in Italy. J Hepatol. 1998;29:944–52.

    Article  CAS  PubMed  Google Scholar 

  8. El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med. 1999;340:745–50.

    Article  CAS  PubMed  Google Scholar 

  9. Annual Report 1987. National Cancer Registry Programme. New Delhi, Indian Council of Medical Research, 1990

  10. Jayant K, Rao RS, Nene BM, Dale PS. Rural cancer registry at Barshi—Report 1988–92. Rural Cancer Registry: Barshi; 1994.

    Google Scholar 

  11. Kumar R, Saraswat MK, Sharma BC, Sakhuja P, Sarin SK. Characteristics of hepatocellular carcinoma in India: a retrospective analysis of 191 cases. Q J Med. 2008;101:479–85.

    Article  CAS  Google Scholar 

  12. Di Bisceglie AM. Hepatitis B and hepatocellular carcinoma. Hepatology. 2009;49:S56–60.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Paul SB, Chalamalasetty SB, Vishnubhatla S, et al. Clinical profile, etiology and therapeutic outcome in 324 hepatocellular carcinoma patients at a tertiary care center in India. Oncology. 2009;77:162–71.

    Article  PubMed  Google Scholar 

  14. Kumar M, Kumar R, Hissar SS, et al. Risk factors analysis for hepatocellular carcinoma in patients with and without cirrhosis: a case–control study of 213 hepatocellular carcinoma patients from India. J Gastroenterol Hepatol. 2007;22:1104–11.

    Article  PubMed  Google Scholar 

  15. Saini N, Bhagat A, Sharma S, Duseja A, Chawla Y. Evaluation of clinical and biochemical parameters in hepatocellular carcinoma: experience from an Indian center. Clin Chim Acta. 2006;371:183–6.

    Article  CAS  PubMed  Google Scholar 

  16. Joshi N, Kumar A, Rani MS, Chandra N, Ramanjaneyulu ER. Clinical and aetiological profile of hepatoma at a tertiary care centre. Trop Gastroenterol. 2003;24:73–5.

    PubMed  Google Scholar 

  17. Sharma S, Sharma B, Chawla YK, et al. Comparison of 7 staging systems in north Indian cohort of hepatocellular carcinoma. Trop Gastroenterol. 2010;31:271–8.

    PubMed  Google Scholar 

  18. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208–36.

    Article  PubMed  Google Scholar 

  19. Durga R, Muralikrishna P. Viral markers in hepatocellular carcinoma. Indian J Gastroenterol. 1994;13:A57.

    Google Scholar 

  20. Kar P, Budhiraja S, Narang A, Das BC, Panda SK, Chakravorty A. Comparative evaluation of serology and polymerase chain reaction for hepatitis C viral infection in liver diseases. Indian J Gastroenterol. 1997;16:118–9.

    CAS  PubMed  Google Scholar 

  21. Sarin SK, Thakur V, Guptan RK, et al. Profile of hepatocellular carcinoma in India: an insight into the possible etiologic associations. J Gastroenterol Hepatol. 2001;16:666–73.

    Article  CAS  PubMed  Google Scholar 

  22. Bosch FX. Global epidemiology of hepatocellular carcinoma. In: Okuda K, Tabor E, (eds). Liver Cancer. New York: Churchill Livingstone; 1997. p. 13–27.

  23. Pyrsopoulos N, Reddy RK. Hepatocellular carcinoma in Asia. In: Sarin SK, Okuda K, (eds). Hepatitis B and C. Carrier to Cancer. Elsevier Sciences: India; 2002. p. 363–4.

  24. Park YM. Hepatocellular carcinoma in Asia. In: Sarin SK, Okuda K, (eds). Hepatitis B and C. Carrier to Cancer. India: Elsevier; 2002. p. 268–71.

  25. Aggarwal R, Naik SR. Prevention of hepatitis B infection: the appropriate strategy for India. Natl Med J India. 1994;7:216–20.

    CAS  PubMed  Google Scholar 

  26. Bosch FX, Ribes J, Diaz M, Cléries R. Primary liver cancer: worldwide incidence and trends. Gastroenterology. 2004;127 5, Suppl 1:S5–S16.

    Google Scholar 

  27. Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006;118:3030–44.

    Article  CAS  PubMed  Google Scholar 

  28. Sundaram C, Reddy CR, Venkataramana G, et al. Hepatitis B surface antigen, hepatocellular carcinoma and cirrhosis in south India—an autopsy study. Indian J Pathol Microbiol. 1990;33:334–8.

    CAS  PubMed  Google Scholar 

  29. Kumar A, Sreenivas DV, Nagarjuna YR. Hepatocellular carcinoma. The Indian scenario. Indian J Gastroenterol. 1995;14:A95.

    Google Scholar 

  30. Abbasi A, Butt N, Bhutto AR, Gulzar K, Munir SM. Hepatocellular carcinoma: a clinicopathological study. J Coll Physicians Surg Pak. 2010;20:510–3.

    PubMed  Google Scholar 

  31. Butt AK, Khan AA, Alam A, et al. Hepatocellular carcinoma: analysis of 76 cases. J Pak Med Assoc. 1998;48:197–201.

    CAS  PubMed  Google Scholar 

  32. Ramesh R, Munshi A, Panda SK. Prevalence of hepatitis C virus antibodies in chronic liver disease and hepatocellular carcinoma patients in India. J Gastroenterol Hepatol. 1992;7:393–5.

    Article  CAS  PubMed  Google Scholar 

  33. Patil S, Bhuyan BK, Nanda BK. A study of ninety-three cases of primary carcinoma of liver. Indian J Pathol Microbiol. 1982;25:135–8.

    CAS  PubMed  Google Scholar 

  34. Prabhakar V, Rao KS, Reddy DJ. Primary carcinoma of liver in Vishakhapatnam. Indian J Pathol Microbiol. 1966;9:54–60.

    CAS  Google Scholar 

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Sood, A., Midha, V., Goyal, O. et al. Profile of hepatocellular carcinoma in a tertiary care hospital in Punjab in northern India. Indian J Gastroenterol 33, 35–40 (2014). https://doi.org/10.1007/s12664-013-0373-7

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