Demographics and Treatment Outcomes of Hepatocellular Carcinoma: A Retrospective Study in Single Tertiary Care Hospital

Abstract

Background: Hepatocellular carcinoma (HCC) is one of the most common cancers in Thailand. There are various treatment modalities for HCC. Most patients with HCC are diagnosed at an advanced stage resulting in limited treatment options and poor outcomes. Objective: To assess the demographic characteristics and outcomes of patients with HCC at HRH Princess Maha Chakri Sirindhorn Medical Center. Materials and Methods: A retrospective study was conducted, involving patients aged 18 years and older diagnosed with HCC between January 2011 and August 2021. All clinical information and laboratory and radiologic findings were collected. Results: Among 538 HCC patients, 430 were males, with a mean age of 58.8 years. Hepatitis B was the most common risk factor at 48.9%, and 92.4% of patients had cirrhosis. Abdominal pain was the predominant presenting symptom. Only 5.2% of patients were identified through the surveillance program. Asymptomatic patients identified through the surveillance program showed better survival rates compared to those who were not detected through the program, with a median survival of 37.2 months versus 27.6 months, respectively (p=0.035). Patients were classified by the Barcelona Clinic Liver Cancer (BCLC) stage as follows, 6.2% at stage 0, 31.0% at stage 1, 23.0% at stage 2, 30.1% at stage 3, and 9.7% at stage 4. Portal vein thrombosis was presented in 26.9% of the patients. Treatment modalities included resection for 3.5%, radiofrequency ablation for 3.2%, transarterial chemoembolization for 71.2%, targeted therapy for 1.3%, chemotherapy for 4.5%, and best supportive care for 9.3%. The median survival time was 14.4 months. Factors associated with mortality included the year of diagnosis between 2011 and 2016, presence of diabetes mellitus (DM), chronic kidney disease (CKD), abdominal pain, weight loss, jaundice, Child-Turcotte-Pugh (CTP) score of B or C, BCLC stage 4, infiltrative tumor type, tumor size larger than 5 cm, tumor rupture, presence of metastasis, alpha-fetoprotein (AFP) levels equal to or greater than 200 IU/mL, and not receiving specific treatment. Conclusion: HCC patients continued to have a poor prognosis. Patients identified through the surveillance program had better survival rates than those who were not, but only a minority of patients were detected through this program. Therefore, encouraging the surveillance program is crucial.