Epidemiology of patients with hepatocellular carcinoma in a universitary hospital during a 12-year period: a cohort study
Francisco Calderon Novoa7, Lucas Caram7, Esteban Masino7, Ezequiel Mauro2, Leila Haddad2, Adrian Gadano2, Sebastian Marciano2, Jimena Vicens3, Valeria Aliperti3, Cristina Elizondo3, Vanina Pagotto3, Juan C Spina6, Ricardo Garcia Monaco5, Eduardo Mullen4, Victoria Ardilles1,7, Eduardo De Santibañes1,7, Juan Pekolj1,7, Martin De Santibañes1,7.
1HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 2Department of Hepatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 3Department of Epidemiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 4Pathology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 5Interventional Radiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 6Diagnostics Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 7General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Introduction: Hepatocellular carcinoma is the most common primary liver tumor, with 905 677 cases diagnosed to date, and 830 180 deaths. In Argentina, it accounts for the 9th cause of death for cancer in men and the 10th in women. Unlike other highly-prevalent tumors, scientific evidence for most therapeutic options is limited mainly to small cohorts and retrospective studies. The aim of this study is to characterize and describe epidemiologically patients with diagnosis of hepatocellular carcinoma in the Italian Hospital of Buenos Aires during a 12 year period.
Methods: A retrospective, observational analitical cohort study was performed. All patients over 18 years diagnosed with Hepatocelullar carcinoma between January 2007 and December 2018 were included. The study was aproved by the institional ethics comitee. Data was obtained from electronic medical records. Patients were diagnosed with HCC using national guidelines until 2011, and LI-RADS system afterwards. patients were staged acording to BCLC criteria, and were divided into three different groups according to the treatment: curative intent treatments (surgical resection, liver transplant or radiofrequency ablation), non-curative treatments (Transarterial chemoembolization, transarterial radioembolization, Sorafenib) and paliative treatments.
Results: Overall survival for our cohort was 58%, 46%, and 36% at 1, 3 and 5 years respectively. Average survival for patients receiving palliative treatment was 5 months, while those who received either non-curative or curative treatment was 23 and 75 months respectively. Recurrence-free survival for those patients who underwent a curative treatment was 89%, 76% y 61% at 1, 3 and 5 years. Patients recieving liver transplant had the best RFS, with 98%, 89% and 77% at 1, 3 and 5 years respectively. Out of 400 cirrhotic patients, almost 60% (231 patients) were BCLC A at diagnosis, 147 patients were BCLC B, and 18 patients BCLC C-D. Mean OS for these groups was 39 months, 21 months and 4 months respectively. Of 231 BCLC A patients, 92 patients had Liver transplant perfomed, and 50 of these requiered bridging therapies to be elegible candidates for LT. In the BCLC B group, 6 patients had LT performed, previous TACE so as to become elegible candidates. 121 patients presented HCC in a non-cirrhotic liver. 52% of these patients recieved surgical resection, while 36 patients recieved some other kind of treatment (TACE,TARE, Chemotherapy, Sorafenib or a combination of these). Follow-up time for these patientes was 35 months.
Conclusions: A thorough analysis of etiology, risk factors, incidence, mortality and treatment was made. Results are in consonance with worldwide reports, showing the aplicabilty of BCLC criteria and management in a high volume center in a developing country. The study’s importance lies in its large sample size, quantity and quality of data, and will most certainly stimulate the development of local studies in hepatocellular carcinoma.
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