Review of 336 patients with hepatocellular carcinoma at Songklanagarind Hospital

Abstract

AIM:To determine the clinical presentations, survival and prognostic factors of hepatocellular carcinoma (HCC) in Southern Thailand.METHODS:Retrospective analysis was performed on the 336 hepatocellular carcinoma patients treated at Songklanagarind hospital between 1 January 1991 and 31 January 1999.RESULTS:Of these 336 patients, 276 were males and 60 were females. The mean age was 54.4 years. The common symptoms and signs were abdominal pain and hepatomegaly. The most common presentation of tumor was a dominant mass with daughter nodules. Portal vein involvement was found in 50% of total. Extrahepatic metastasis was found in 13%, and the lung was the most common site. There were 65.4% with evidence of cirrhosis and half of them were in Child's class B. HBsAg was positive in 72.6%. Regarding a(c)Okuda's tumor staging, 15%, 61% and 24% were stage I, II and III, respectively. Overall median survival was 2.1 months (11.5 2.6 and 0.7 months for stage I, II and III respectively). Treatments of HCC improved patient survival (5.5 months vs 1.6 months for untreated patients). Most common causes of death were hepatic failure. Using multivariate analysis, the prognostic factors identified were tumor staging, alpha-fetoprotein level above 10000&mgr;gcenter dotL(-1), extrahepatic metastasis, portal vein thrombosis and treatment.CONCLUSION:HCC in Thailand is a fatal disease with poor outcome due to late presentation and high prevalence of liver cirrhosis. Early detection and proper management may improve outcome.

Figure 1

Kaplan-Meier survival curve for overall patients. Total (n = 336) median survival of 2.1 months: Okuda's stage I (n = 51), median survival of 11.5 months; Okuda's stage II (n = 205), median survival of 2.6 months; Okuda's stage III (n = 80), median survival of 0.7 months (P = 0.014 and 0.001 respectively).

Figure 2

Kaplan-Meier survival curve in relation to treatment or non-treatment. Treated group (n = 91), median survival of 5.5 months; non-treated group (n = 245), median survival of 1.6 months (P = 0.011).

Figure 3

Kaplan-Meier survival curve in non-treated group. Total (n = 245), median survival of 1.6 months, Okuda's stage I (n = 26), median survival of 7.7 months; Okuda's stage II (n = 146), median survival of 1.8 months; Okuda's stage III (n = 73), median survival of 0.6 months.