Factors Affecting Short Life Expectancy of Untreated Hepatocellular Carcinoma Patients after Diagnosis
Keywords:
Hepatocellular carcinoma, Untreated, Prognostic factorsAbstract
Objective: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer deaths in Thailand, and there are very few studies which describe the prognostic factors that affect survival. The aim of the present study is to identify factors associated with survival of untreated HCC patients in Lampang, Thailand.
Materials & Methods: A retrospective cohort study design. Patients diagnosed with malignant neoplasm of liver cell carcinoma during the years 2011 to 2015 were enrolled. Patients with insufficient data, misdiagnosed, or who received any treatment were excluded. The characteristics were compared between dead and survived groups by using t-test and exact probability test. Univariable analysis and multivariable analysis were done by using logistic regression analysis. Prognostic factors were considered significant if the p-value < 0.05.
Results: One hundred and eleven untreated patients were analyzed. Median survival was 87 days (2.9 months). In multivariable analysis, presence of cirrhosis (OR=21.72, 95% CI = 1.83-257.72, p = 0.015), large ascites (OR = 3.38, 95% CI = 1.068-10.79, p = 0.040), and hepatic venous outflow obstruction (HVOO, OR = 5.43, 95% CI = 1.05-27.94, p = 0.043) were associated with death from HCC.
Conclusions: The presence of cirrhosis, large ascites, and HVOO were found to be significantly associated with short life expectancy of untreated HCC patients.
References
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40. Liu FY, Wang MQ, Duan G, et al. Hepatocellular carcinoma associated with budd-chiari syndrome: imaging features and transcatheter arterial chemoembolization. BMC Gastroenterology. 2013;13:105.
41. Kao WY, Hung HH, Lu HC, et al. Hepatocellular carcinoma with presentation of Budd-Chiari syndrome. J Chin Med Assoc 2012; 73: 93-6.
42. Paul SB, Shalimar, Sreenivas V, et al. Incidence and risk factors of hepatocellular carcinoma in patients with hepatic venous outflow tract obstruction. Aliment Pharmacol Ther 2015;41: 961-71.
43. Sakr M, Abdelhakam SM, Dabbous H, et al. Characteristics of hepatocellular carcinoma in Egyptian patients with primary Budd-Chiari syndrome. Liver Int 2017; 37: 415.
2. Ghouri YA, Mian I, Rowe JH. Review of hepatocellular carcinoma: epidemiology, etiology, and carcinogenesis. J Carcinog 2017;16:1.
3. Omata M, Cheng AL, Kokudo N, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int 2017;11: 317-70.
4. European association for the study of the liver. EASL guidelines: management of hepatocellular carcinoma. J Hepatol 2018 https://doi.org/10.1016/j.jhep.2018.03.019.
5. Liu PH, Hsu CY, Hsia CY, et al. Prognosis of hepatocellular carcinoma: assessment of eleven staging system. J hepatol 2016;4:601-8.
6. Yau T, Tang VYF, Yao TJ, et al. Development of Hong Kong liver cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterol 2014;146:1691-700.
7. สมาคมโรคตับแห่งประเทศไทย. แนวทางการดูแลผู้ป่วยมะเร็งตับในประเทศไทย ปี พ.ศ.2558. กรุงเทพมหานคร: ภาพพิมพ์, 2558.
8. Tandon P and Garcia-Tsao G. Prognostic indicators in hepatocellular carcinoma: a systematic review of 72 studies. Liver Int 2009;29:502-10.
9. CLIP investigators. Prospective validation of the CLIP score: a new prognostic system for patients with cirrhosis and hepatocellular carcinoma. Hepatology. 2000;31:840-4.
10. Okuda K, Ohtsuki T, Obata H, et al. Natural history of hepatocellular carcinoma and prognosis in relation to treatment: a study of 850 patients. Cancer. 2006;4:918-28.
11. Primack A, Vogel CL, Kyalwazi S, et al. A staging system of hepatocellular carcinoma: prognostic factors in Ugandan patients. Cancer. 2006;35:1357-64.
12. Zeeneldin AA, Salem S, Darwish AD, et al. Untreated hepatocellular carcinoma in Egypt: outcome and prognostic factors. J Hepatocell Carcinoma 2015;2:3-9.
13. Marrero JA, Fontana RJ, Barrat A, et al. Prognostic of hepatocellular carcinoma: Comparison of 7 staging systems in an American cohort. Hepatology 2005;41:707-16.
14. Chan AWH, Chan SL, Mo FKF, et al. albumin-to-alkaline phosphase ratio: a novel prognostic index for hepatocellular carcinoma. Dis Markers 2015 https://doi.org/10.1155/2015/564057.
15. Giannini EG, Moscatelli A, Pellegatta G, et al. Application of the intermediate-stage subclassification to patients with untreated hepatocellular carcinoma. Am J Gastroenterol 2016; 111:70-7.
16. Yeung YP, Lo CM, Liu CL, et al. Natural history of untreated nonsurgical hepatocellular carcinoma. Am J Gastroenterol 2005; 100:1995-2004.
17. Sombbon K, Siramolpiwat S, Vilaichone R. Epidemiology and Survival of Hepatocellular Carcinoma in the Central Region of Thailand. Asian Pac J Cancer Prev 2014;15:3567-70.
18. Kim UB, Doo CJ, Baek SH, et al. Natural history and prognostic factors of primary hepatocellular carcinoma: study of 70 untreated patients. Korean J Int Med 1989;4:136-41.
19. Greten TF, Papendorf F, Bleck JS, et al. Survival rate in patients with hepatocellular carcinoma: a retrospective analysis of 389 patients. Bri J Cancer 2005;92:1862-8.
20. Pawarode A, Voravud N, Sriuranpong V, et al. Natural history of untreated primary hepatocellular carcinoma: a retrospective study of 157 patients. Am J Clin Oncol 1998;2:386-91.
21. Imokaw Y, Kuda K, Bo YA, et al. Serum glutamic oxalacetic transaminase/glutamic pyruvic transaminase ratios in hepatocellular carcinoma. Cancer 1977;40:319-24.
22. Chan AWH, Chan SL, Mo FKF, et al. Albumin-to-alkaline phosphatase ratio: A novel prognostic index for hepatocellular carcinoma. Dis Markers 2015 http://dx.doi.org/10.1155/2015/564057.
23. Nouso K, Ito YM, Kuwaki K, et al. Prognostic factors and treatment effects for hepatocellular carcinoma in child c cirrhosis. Br J Cancer 2008;98:1161-5.
24. Child CG, Turcotte JG. Surgery and portal hypertension. Maj Probl Clin Surg. 1964;1:1-85.
25. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the esophagus for bleeding oesophageal varices. Br J Surg 1973;60:646-9.
26. Arizumi T, Minami T, Chishina H, et al. Impact of tumor factors on survival in patients with hepatocellular carcinoma classified based on Kinki criteria stage B2. Dig Dis 2017;35:583-8.
27. Garcia-Tsao G. The Child-Turcotte classification: from gestalt to sophisticated statistics and back. Dig Dis Sci 2016; 61: 3102-4.
28. Yu YQ, Li J, Liao Y, et al. The preoperative alkaline phosphatase-to-platelet ratio index is an independent prognostic factor for hepatocellular carcinoma after hepatic resection. Medicine 2016; 95(51): e5734 doi: 10.1097/MD.0000000000005734.
29. Kamath PS, Kim WR. The model for end-stage liver disease (MELD): reviews. Hepatol 2007;45(3):797-805.
30. Hsieh WY, Chen PH, Lin IY, et al. The impact of esophagogastric varices on the prognosis of patients with hepatocellular carcinoma. Sci Rep 7:42577 | DOI: 10.1038/srep42577.
31. Giannini EG, Risso D, Testa R, et al. Prevalence and prognostic significance of the presence of esophageal varices in patients with hepatocellular carcinoma. Clin Gastroenterol Hepatol 2006;4:1378-84.
32. Giannini EG, Farinati F, Ciccarese F, et al. Prognosis of untreated hepatocellular carcinoma. Hepatology 2015;61:184-90.
33. Zeeneldin AA, Salem SE, Darwish AD, et al. Untreated hepatocellular carcinoma in Egypt: outcome and prognostic factors. J Hepatocell Carcinoma 2015;2:3-9.
34. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet 2008; 371: 838-51.
35. Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL, Loscalzo J. Harrison’s principles of internal medicine. 18th ed. McGraw Hill, 2012.
36. Bayraktar UD, Seren S, Bayraktar Y. Hepatic venous outflow obstruction: three similar syndromes. World J Gastroenterol 2007; 13:1912-27.
37. Shrestha SM. Hepatic venous outflow obstruction: suggestion of a new classification. J Ren Hepat Disord 2017;1:41–51.
38. Moucari R, Rautou PE, Cazals-Hatem D, et al. Hepatocellular carcinoma in Budd-Chiari syndrome:characteristics and risk factors. Gut 2008;57:828-35.
39. Park H, Yoon JY, Park KH, et al. Hepatocellular carcinoma in Budd-Chiari syndrome: A single center experience with long-term follow-up in South Korea. World J Gastroenterol 2012;18: 1946-52.
40. Liu FY, Wang MQ, Duan G, et al. Hepatocellular carcinoma associated with budd-chiari syndrome: imaging features and transcatheter arterial chemoembolization. BMC Gastroenterology. 2013;13:105.
41. Kao WY, Hung HH, Lu HC, et al. Hepatocellular carcinoma with presentation of Budd-Chiari syndrome. J Chin Med Assoc 2012; 73: 93-6.
42. Paul SB, Shalimar, Sreenivas V, et al. Incidence and risk factors of hepatocellular carcinoma in patients with hepatic venous outflow tract obstruction. Aliment Pharmacol Ther 2015;41: 961-71.
43. Sakr M, Abdelhakam SM, Dabbous H, et al. Characteristics of hepatocellular carcinoma in Egyptian patients with primary Budd-Chiari syndrome. Liver Int 2017; 37: 415.
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2019-06-30
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Jansiriyotin P, Chantip A. Factors Affecting Short Life Expectancy of Untreated Hepatocellular Carcinoma Patients after Diagnosis. Thai J Surg [Internet]. 2019 Jun. 30 [cited 2024 May 3];40(2):35-43. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/243912
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