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)