Determinants of survival following hepatocellular carcinoma in Egyptian patients with untreated chronic HCV infection in the pre-DAA era

Abstract

Background and study aims: In this study we assessed rates and determinants of survival in people with untreated chronic HCV infection and hepatocellular carcinoma (HCC) in an Egyptian liver clinic setting.

Patients and methods: This is a prospective cohort study of patients diagnosed with HCV-related HCC and undergoing HCC management at a national liver centre in Egypt in 2013-2014 and with a follow-up through 2016.

Results: A total of 345 patients diagnosed with HCV-related liver cirrhosis complicated by HCC were included. Median age at diagnosis was 57 years (IQR = 52, 62), the majority were male (78%) and Child-Turcotte-Pugh (CTP) class A (64%). At diagnosis Barcelona Clinic Liver Cancer staging (BCLC) was 0 (8%), A (48%), B (20%), C (17%), and D (7%). Most common HCC management modalities were transarterial chemoembolization (TACE) (42%), and radiofrequency ablation (RFA) (21%). Median survival following HCC was 22.8 months. Factors associated with poorer survival in adjusted analyses were INR (HR = 1.81, p = 0.01), alpha-foeto protein (AFP) ≥200 (HR = 1.41, p = 0.02), higher CTP score (HR = 2.48, p < 0.01), and advanced BCLC stage (HR = 1.85, p < 0.01). One year survival in patients with CTP A, B, and C was 85%, 71% and 32%, respectively. One year survival following RFA, TACE, combination RFA/TACE, and sorafenib was 93%, 79%, 80% and 60%, respectively.

Conclusion: Survival following HCV-HCC in Egyptian patients undergoing HCC management in a specialised clinic setting is poor, although similar to high income country settings. CTP score is a key determinant of survival, even following adjustment for BCLC stage and HCC management.

Keywords: Egypt; Hepatitis C virus; Hepatocellular carcinoma; Survival.