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K. Yasui, E. Hashimoto, Y. Komorizono, K. Koike, S. Arii, Y. Imai, T. Shiima, Y. Kanbara, T. Saibara, T. Mori, S. Kawata, H. Uto, S. Takami, S. Sumida, T. Takamura, M. Kawanaka, T. Okanoue, Japan NASH Study Group, Ministry of Health Labour and Welfare of Japan, “Characteristics of Patients with Nonalcoholic Steatohepatitis Who Develop Hepatocellular Carcinoma,” Clinical of Gastroenterology and Hepatology, Vol. 9, No. 5, 2011, pp. 428-433. doi:10.1016/j.cgh.2011.01.023

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• TITLE: Hepatocellular Carcinoma: Risk Factors, Diagnosis, Staging and Treatment in a Referral Centre

  AUTHORS: Raphael Raphe, Willian J. Duca, Paulo C. Arroyo Jr., Rita C. da Silva, Renato F. da Silva

  KEYWORDS: Hepatocellular Carcinoma; Epidemiology; Risk Factors; Liver Cancer; Hepatitis; Alcohol

  JOURNAL NAME: Journal of Cancer Therapy, Vol.4 No.2A, February 28, 2013

  ABSTRACT: Introduction: Hepatocellular carcinoma is the most common primary neoplasm of the liver and a significant cause of mortality in patients with cirrhosis. A retrospective cross-sectional study was performed to analyze epidemiological aspects related to risk factors, diagnosis, staging and first-line treatment in a closed population. Methods: The medical records of patients seen between November 1998 and May 2011 were revisited. Results: Of the 272 patients included in this study, 229 (84.2%) were male and the average age was 57.1 years (standard deviation 10.9 years). The most common etiology was hepatitis C virus infection in 145 (55.1%) patients, with this being the single cause in 88 (33.4%) patients. The largest masses ranged from 6 mm to 260 mm in diameter with a mean of 61.4 mm (standard deviation 41.5 mm). Only one mass was found in 145 (64.2%) cases, two masses in 26 (11.5%), three masses in 9 (4%) and 46 patients (20.3%) had multifocal disease. Early stage disease was diagnosed in 47 patients (22.0%), advanced stage in 65 (30.4%) and terminal stage in 32 (14.9%). Hepatocellular carcinoma was found by chance in 11%. Diagnosis was by means of imaging in 175 (68.1%) cases. The level of alpha-fetoprotein was measured in 209 patients, with 29.2% having levels lower than 20 ng/mL and 34.9% having levels above 400 ng/mL. Specific treatment was administered in 236 patients (86.8%) with hepatic chemoembolization in 127 (46.7%) and liver transplantation in 72 (26.5%); of these 33 (45.8%) received hepatic chemoembolization as a bridge to transplantation. Thirty-four patients (12.5%) received only supportive therapy. Conclusions: Patients are chiefly male and disease involvement generally occurs in the 5th decade of life. Cirrhosis was present in most patients and hepatitis C virus infection was the commonest etiologic agent. Only one imaging examination was required for diagnosis in most patients. The measurement of alpha-fetoprotein levels did not prove to be a good tool in the diagnosis of hepatocellular carcinoma. Intermediate, advanced and terminal stages predominated compared to early stages. Treatment was based on non-curative therapies.