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

Abstract

\n 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 + palliative care group (9 month) then sorafenib + palliative care and palliative care alone group (5 and 4 months respectively). Although results were not statistically significant (p: 0.133). Amongst all possible variables, highest hazard was found with multifocal lesion (2.0577) and results were statistically significantly (p 0.0451, 95 % confidence interval : 0.9225 to 4.5900 ) as compared to unifocal lesion with median survival period of 7 vs 9.5 months by Kaplan-Meier survival curve analysis using log rank test. Conclusion: Multifocality was independent predicator for poor survival in HCC. Further clinical studies are necessary to improve the outcomes of patients with high risk features.