RESULTS
We enrolled and analyzed 54 patients who had hepatocellular carcinoma.
The youngest patient in our study was 28 years old, the oldest was of
81years, and the mean age was 57.17 years. Of them, 46 (85.18%) were
male and 8 (14.82%) were female. The majority of the patients in the
study followed Hinduism (75.93%). Of the total participants, 37
(68.52%) consumed alcohol and a majority of them were smokers
(74.07%). Comorbidity in the form of diabetes mellitus was present in
five patients (9.26%), hypertension in six patients (14.81%), and both
diabetes and hypertension were present in eight patients (11.11%)
(Table 1).
We also analyzed all the patients to determine the possible etiologies
of HCC. The study depicted that, alcohol abuse was the commonest cause
of HCC (38.89%) followed by chronic viral hepatitis B (CHB) infection
(11.11%). In addition, 12 patients (22.22%) had a history of both
significant alcohol consumption as well as CHB infection (Table 2).
At the time of diagnosis, most of the patients were symptomatic
(88.89%). The commonest presenting symptoms were weight loss (64.81%),
abdominal distension (61.11%), anorexia (61.11%), and abdominal pain
(50.0%). Ascites was present in more than half of the patients
(59.26%) and hepatic encephalopathy was found in only four patients
(7.41%) (Table 3).
All patients underwent imaging by either triple phase CT scan or an MRI
of the abdomen. The HCC most commonly involved the right lobe of liver
(55.56%) followed by the bilobar involvement (29.63%). The left lobe
was involved in eight patients (14.78%). Multicentric HCC with more
than three lesions was the most common radiological pattern (35.19%)
followed by the single lesion (27.78%). Vascular involvement of the
porto-splenic axis was seen in nearly half of the patients (44.44%).
Extrahepatic spread of the tumor was seen in eight patients (14.81%).
Four patients (7.41%) had regional periportal lymph node involvement,
two (3.70%) had metastasis to the lung, and the remaining two (3.70%)
had metastasis to the peritoneum. On detailed evaluation, 42 patients
(77.78%) were found to have underlying liver cirrhosis. The majority of
cirrhotic patients had already progressed to the decompensated stage
(80.95%).
Child-Turcotte-Pugh (CTP) status was calculated in all patients. The
analysis depicted that 23 (42.59%) patients had CTP A, 14 (25.93%) had
CTP B, and 17 (31.48%) had CTP C. Functional status was assessed by
using Eastern Cooperative Oncology Group (ECOG) performance status, and
most common performance status was ECOG 0 (37.04%) followed by ECOG 2
(20.37%) and ECOG 3 (20.37%). Based on tumor characteristics, CTP
score, and ECOG performance status, BCLC (Barcelona Clinic Liver Cancer
(BCLC) staging was done. The analysis showed that the majority of the
participants belonged to the terminal stage (BCLC category D) (38.89%)
followed by the advanced stage (BCLC category C) (35.19%). None of our
patients was detected in the very early stage (BCLC category 0). (Table
4)
The evaluation of laboratory parameters among the participants
demonstrated that the serum alpha-fetoprotein was elevated in 44
patients (81.48%) with a mean value of 525±37 ng/ml. The majority of
the patients were anemic with a mean value of hemoglobin of 10.9±2.7
g/dl. The mean values of serum sodium level, AST, and ALT were within
normal limits, however, mean serum alkaline phosphatase (ALP) was raised
as shown in Table 5. The mean values of CTP score, Model for End-Stage
Liver Disease (MELD) score, and MELD-Na score were also calculated.
(Table 5)
Most of the patients (92.59%) underwent non-surgical treatment and only
four patients underwent surgical treatment i.e., tumor resection. Among
non-surgical treatment modalities, only 2 patients underwent therapy
with curative intent in the form of microwave ablation. As most of our
patients were in the terminal stage (BCLC D), they were provided with
the best supportive care. Some patients received transarterial
chemoembolization (TACE) (50.0%) and chemotherapy with sorafenib
(31.48%) as palliative therapeutic measures. (Table 6)