Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Epidemiology and Survival of Hepatocellular Carcinoma in North-east Peninsular Malaysia

  • Norsa'adah, Bachok (Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia) ;
  • Nurhazalini-Zayani, Che Ghazali Che (Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia)
  • Published : 2013.11.30
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Abstract

The incidence of hepatocellular carcinoma (HCC) is relatively high in Southeast Asia. Globally, HCC has a high fatality rate and short survival. The objectives of this retrospective cohort study were to review the epidemiology and survival of HCC patients at a tertiary centre in north-east of Peninsular Malaysia. Subjects were adult HCC patients diagnosed by histopathology or radio-imaging. Secondary liver carcinoma was excluded. Kaplan Meier and multiple Cox proportional hazard survival analyses were used. Only 210 HCC cases from years 1987-2008, were included in the final analysis. The number of cases was increasing annually. The mean age was 55.0 (SD 13.9) years with male:female ratio of 3.7:1. Approximately 57.6% had positive hepatitis B virus, 2.4% hepatitis C virus, 20% liver cirrhosis and 8.1% chronic liver disease. Only 2.9% had family history and 9.0% had frequently consumed alcohol. Most patients presented with abdominal pain or discomfort and had hepatomegaly, 47.9% had an elevated ${\alpha}$-fetoprotein level of 800 IU/ml or more, 51.9% had multiple tumors and 44.8% involved multiple liver lobes. Approximately 63.3% were in stage 3 and 23.4% in stage 4, and 82.9% did not receive any treatment. The overall median survival time was 1.9 months (95% confidence interval (CI): 1.5, 2.3). The 1-month, 6-month, 1-year and 2-year survival rates were 71.8%, 23.3%, 13.0% and 7.3% respectively. Significant prognostic factors were Malay ethnicity [Adjusted hazard ratio (AHR) 1.6; 95%CI: 1.0, 2.5; p=0.030], no chemotherapy [AHR 1.7; 95%CI: 1.1, 2.5; p=0.017] and Child-Pugh class C [AHR 2.6; 95%CI: 1.4, 4.9; p=0.002]. HCC in our study affected a wide age range, mostly male, in advanced stage of disease, with no treatment and very low survival rates. Primary prevention should be advocated in view of late presentation and difficulty of treatment. Vaccination of hepatitis virus and avoidance of liver toxins are to be encouraged.

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References

  1. Befeler AS, Di Bisceglie AM (2002). Hepatoellular carcinoma: diagnosis and treatment. Gastroenterol, 122, 1609-19. https://doi.org/10.1053/gast.2002.33411
  2. Bosch FX, Ribes J, Diaz M, Cleries R (2004). Primary liver cancer: worldwide incidence and trends. Gatroenterol, 127, 5-16. https://doi.org/10.1016/S0016-5085(04)01170-9
  3. Bruix J, Llovet JM (2002). Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatol, 35, 519-24. https://doi.org/10.1053/jhep.2002.32089
  4. Bruix J, Sherman M, Llovet JM, et al (2001). Clinical management of hepatocellular carcinoma.Conclusions of the Barcelona-2000 EASL Conference. J Hepatol, 35, 421-30. https://doi.org/10.1016/S0168-8278(01)00130-1
  5. Chen CJ, Yu MW, Liaw YF (1997). Epidemiological characteristics and risk factors of hepatocellular carcinoma. J Gastroenterol Hepatol, 12, 294-308. https://doi.org/10.1111/j.1440-1746.1997.tb00513.x
  6. Deuffic S, Poynard T, Buffat L, Valleron AJ (1998). Trends in primary liver cancer. Lancet, 351, 214-5.
  7. El-Serag H, Rudolf L (2007). Reviews in basic and clinical gastroenterology. Gastroenterol, 132, 2557-76. https://doi.org/10.1053/j.gastro.2007.04.061
  8. El-Serag HB, Davila JA, Petersen NJ, McGlynn KA (2003). The continuing increase in the incidence of hepatocellular carcinoma in the United States: an update. Ann Intern Med, 139, 817-23. https://doi.org/10.7326/0003-4819-139-10-200311180-00009
  9. Gao J, Xie L, Yang WS, et al (2012). Risk factors of hepatocellular carcinoma - current status and perspectives. Asian Pac J Cancer Prev, 13, 743-52. https://doi.org/10.7314/APJCP.2012.13.3.743
  10. Groen KA (1999). Primary and metastatic liver cancer. Sem Oncol Nurs, 15, 48-57. https://doi.org/10.1016/S0749-2081(99)80039-4
  11. Hasegawa K, Kokudo N (2009). Surgical treatment of hepatocellular carcinoma. Surg Today, 39, 833-43. https://doi.org/10.1007/s00595-008-4024-z
  12. Kansa-ard S, Wiangnon S, Suwanrungruang K, et al (2011). Trends in liver cancer incidence between 1985 and 2009, Khon Kaen, Thailand: cholagiocarcinoma. Asian Pac J Cancer Prev, 12, 2209-13.
  13. Llovet JM, Real MI, Montana X, et al (2002). Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet, 359, 1734-9. https://doi.org/10.1016/S0140-6736(02)08649-X
  14. Nguyen VTT, Law MG, Dore GJ (2009). Hepatitis B-related hepatocellular carcinoma: epidemiological characteristics and disease burden. J Virus Hepatitis, 16, 453-63. https://doi.org/10.1111/j.1365-2893.2009.01117.x
  15. Nordenstedt H, White DL, El-Serag HB (2010).The changing pattern of epidemiology in hepatocellular carcinoma. Dig Liver Dis, 42, 206-14. https://doi.org/10.1016/S1590-8658(10)60507-5
  16. Okuda K, Ohtsuki T, Obata H, et al (1985). Natural history of hepatocellular carcinoma and prognosis in relation to treatment study of 850 patients. Cancer, 56, 918-28. https://doi.org/10.1002/1097-0142(19850815)56:4<918::AID-CNCR2820560437>3.0.CO;2-E
  17. Sangro B, Herraiz M, Martinez-Gonzalez MA, et al (1998). Prognosis of hepatocellular carcinoma in relation to treatment: a multivariate analysis of 178 patients from a single European institution. Surg, 124, 575-83. https://doi.org/10.1016/S0039-6060(98)70105-9
  18. Siegel R, Ward E, Brawley O, Jemal A (2011). Cancer statistics, 2011. The impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin, 61, 212-36. https://doi.org/10.3322/caac.20121
  19. Soong RS, Yu MC, Chan KM, et al (2011). Analysis of the recurrence risk factors for the patients with hepatocellular carcinoma meeting University of California San Francisco criteria after curative hepatectomy. World J Surg Oncol, 9, 9. https://doi.org/10.1186/1477-7819-9-9
  20. Srivatanakul P, Sriplung H, Deerasamee S (2004). Epidemiology of liver cancer: an overview. Asian Pac J Cancer Prev, 5, 118-25.
  21. Takano S, Watanabe Y, Ohishi H, et al (2000). Multinodality treatment for patients with hepatocellular carcinoma: a single institution retrospective series. Eur J Surg Oncol, 26, 67-72. https://doi.org/10.1053/ejso.1999.0743
  22. Teo EK, Fock KM (2001). Hepatocellular carcinoma: an Asian perspective. Dig Dis, 19, 263-8. https://doi.org/10.1159/000050692
  23. Trevisani F, D’Intino PE, Grazi GL, et al (1996). Clinical and pathologic features of hepatocellular carcinoma in young and olderItalian patients. Cancer, 77, 2223-32. https://doi.org/10.1002/(SICI)1097-0142(19960601)77:11<2223::AID-CNCR7>3.0.CO;2-Q
  24. Verhoef V, Visser O, de Man RA, et al (2004). Hepatocellular carcinoma in the Netherlands incidence, treatment and survival patterns. Eur J Cancer, 40, 1530-8. https://doi.org/10.1016/j.ejca.2004.03.013
  25. Wong R, Corley DA (2008). Racial and ethnic variations in hepatocellular carcinoma incidence within the United States. Am J Med, 121, 525-31. https://doi.org/10.1016/j.amjmed.2008.03.005
  26. Yusuf MA, Badar F, Meerza F, et al (2007). Survival from hepatocellular carcinoma at a cancer hospital in Pakistan. Asian Pac J Cancer Prev, 8, 272-4.
  27. Zainal AO, Nor Saleha IT (2011). National Cancer Registry Report. Malaysia Cancer Statistics- Data and Figure 2007. National Cancer Registry, Ministry of Health Malaysia: Kuala Lumpur.
  28. Zhou XD, Tang ZY, Yang BH, Zhang BH (2000). Hepatocellular carcinoma: the role of screening. Asian Pac J Cancer Prev, 1, 121-6.

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