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  • 1 SMS Medical College Department of Gastroenterology Jaipur India
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Aims and Objective: There is dearth of data on clinical, biochemical, virological and etiological parameters in hepatocellular carcinoma (HCC) patients from India. HCC is the most common primary liver malignancy. We enrolled HCC patients to study their clinical, biochemical, virological and etiological parameters and to see the association of viral load and tumor character. Material and Methods: This was a prospective study from June 2005 to May 2007 enrolling newly diagnosed patients of HCC. The diagnosis was based on fulfilment of two of the three criteria (a) Alpha-fetoprotein(AFP) > 300 ng/ml, (b) Dual phase contrast enhanced computed tomography (CECT) of abdomen or magnetic resonance imaging (MRI) evidence of arterialization on arterial phase and wash-out on portal phase, and (c) fine needle aspiration cytology (FNAC) suggestive of hepatocellular carcinoma. The patients’ demographic, clinical profile and characteristics of HCC were studied. Laboratory investigation included hemogram, liver function test, renal function test, coagulogram parameters, ultrasound abdomen, dual phase CECT or MRI abdomen, esophagogastroduodenoscopy, viral markers (HbsAg, HbeAg, anti-HBe, anti-HBc total, HBV DNA, anti-HCV, HCV RNA, ANA, SMA, AMA, S. Iron, S. Ferritin, TIBC, S.ceruloplasmin), AFP and FNAC from liver SOL were done for the etiology of chronic liver disease. Results: Fifty-eight patients of HCC (male: female 49:9) were diagnosed. The mean age was 54.9 (range 21–76 years). The clinical presentation included anorexia in 36 (63%), abdominal pain and distension in 31 (53.4%), jaundice in 10 (20%), fever, mass in epigastrium in 4 (7%) and melena in 2 (3.4%). Forty-nine (84.5%) of them had underlying cirrhosis, diagnosed by ultrasound or computed tomography. Thirty-two (55.2%) patients had raised AFP. The etiology was hepatitis B in 33 (56.8%), hepatitis C in 3(5.1%), alcohol in 6(10.4%) and alcohol and hepatitis B in 2 (3.4%), respectively. Forty-nine (84.5%) had tumor size larger than 5 cm on imaging, the commonest was right lobe involvement in 36 (62%) patients. Portal vein involvement occurred in 28 (49%), inferior vena cava in 5 (8.7%), splenic vein in 4 (7%), and superior mesenteric vein in 1 (1.7%), respectively. FNAC was done in 33 (57%) patients. Sixteen patients had metastases to regional lymph nodes, adrenal and lung. Thirty-two patients died at a mean duration of 4 months (range 1–8 months). None had resectable tumors. HBV-DNA done in 12 patients were more than 4.3 × 10 9 copies/ml and all had tumor size > 5 cm and were unresectable. Conclusion: HCC presented in advanced stage with cirrhosis and venous thrombosis in the majority of patients. Hepatitis B is the etiology in 56.8% of patients. Most of the patients (84.5%) had a large tumor (> 5 cm) at presentation.

  • Yang, H. I., Lu, S. N., Liaw, Y. F. et al.: Hepatitis B e antigen and the risk of hepatocellular carcinoma. N. Engl. J. Med., 2002, 347 , 168–174.

    Liaw Y. F. , 'Hepatitis B e antigen and the risk of hepatocellular carcinoma ' (2002 ) 347 N. Engl. J. Med. : 168 -174.

    • Search Google Scholar
  • Yu, M. W., Yeh, S. H., Chen, P. J. et al.: Hepatitis B virus genotype and DNA level and hepatocellular carcinoma: a prospective study in men. J. Natl. Cancer Inst., 2005, 97 , 265–272.

    Chen P. J. , 'Hepatitis B virus genotype and DNA level and hepatocellular carcinoma: a prospective study in men ' (2005 ) 97 J. Natl. Cancer Inst. : 265 -272.

    • Search Google Scholar
  • Bosch, F. X., Ribes, J., Diaz, M. et al.: Primary liver cancer: Worldwide incidence and trends. Gastroenterology, 2004, 127 , S5–S16.

    Diaz M. , 'Primary liver cancer: Worldwide incidence and trends ' (2004 ) 127 Gastroenterology : S5 -S16.

    • Search Google Scholar
  • Kumar, M., Kumar, R., Hissar, S. S. et al.: Risk factor analysis for hepatocellular carcinoma in patients with and without cirrhosis: A case-control study of 213 hepatocellular carcinoma patients from India. J. Gastroenterol. Hepatol., 2007, 22 , 1104–1111.

    Hissar S. S. , 'Risk factor analysis for hepatocellular carcinoma in patients with and without cirrhosis: A case-control study of 213 hepatocellular carcinoma patients from India ' (2007 ) 22 J. Gastroenterol. Hepatol. : 1104 -1111.

    • Search Google Scholar
  • Llovet, J. M., Beaugrand, M.: Hepatocellular carcinoma: present status and future prospects. J. Hepatol., 2003, 38 , S136–419.

    Beaugrand M. , 'Hepatocellular carcinoma: present status and future prospects ' (2003 ) 38 J. Hepatol. : S136 -419.

    • Search Google Scholar
  • Okuda, K., Nakashima, T., Sakamoto, K. et al.: Hepatocellular carcinoma arising in non-cirrhotic and highly cirrhotic livers: a comparative study of histopathology and frequency of hepatitis B markers. Cancer, 1982, 49 , 450–455.

    Sakamoto K. , 'Hepatocellular carcinoma arising in non-cirrhotic and highly cirrhotic livers: a comparative study of histopathology and frequency of hepatitis B markers ' (1982 ) 49 Cancer : 450 -455.

    • Search Google Scholar
  • Radhika, N. S., Duseja, A., Rajwanshi, A. et al.: Clinico-cytopathological spectrum of HCC, its correlation with serum alpha-fetoprotein level, and hepatitis B and C viral markers. Trop. Gastroenterol., 2004, 25 , 116–120.

    Rajwanshi A. , 'Clinico-cytopathological spectrum of HCC, its correlation with serum alpha-fetoprotein level, and hepatitis B and C viral markers ' (2004 ) 25 Trop. Gastroenterol. : 116 -120.

    • Search Google Scholar
  • Sarin, S. K., Thakur, V., Guptan, R. K. et al.: Profile of hepatocellular carcinoma in India: an insight into the possible etiologic associations. J. Gastroenterol. Hepatol., 2001, 16 , 666–673.

    Guptan R. K. , 'Profile of hepatocellular carcinoma in India: an insight into the possible etiologic associations ' (2001 ) 16 J. Gastroenterol. Hepatol. : 666 -673.

    • Search Google Scholar
  • Yuen, M. F., Chang, C. C., Lauder, I. J. et al.: Early detection of hepatocellular carcinoma increases the chance of treatment: Hong Kong experience. Hepatology, 2000, 31 , 330–335.

    Lauder I. J. , 'Early detection of hepatocellular carcinoma increases the chance of treatment: Hong Kong experience ' (2000 ) 31 Hepatology : 330 -335.

    • Search Google Scholar
  • Bolondi, L., Sofia, S., Siringo, S. et al.: Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: A cost effectiveness analysis. Gut, 2001, 48 , 251–259.

    Siringo S. , 'Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: A cost effectiveness analysis ' (2001 ) 48 Gut : 251 -259.

    • Search Google Scholar
  • Trevisani, F., De Notarius, S., Rapaccini, G. L. et al.: Semiannual and annual surveillance of cirrhotic patients for hepatocellular carcinoma: Effect on cancer stage and patient survival (Italian experience). Am. J. Gastroenterol., 2002, 97 , 734–744.

    Rapaccini G. L. , 'Semiannual and annual surveillance of cirrhotic patients for hepatocellular carcinoma: Effect on cancer stage and patient survival (Italian experience) ' (2002 ) 97 Am. J. Gastroenterol. : 734 -744.

    • Search Google Scholar
  • Chalasani, N., Horlander, J. C. Sr., Said, A. et al.: Screening for hepatocellular carcinoma in patients with advanced cirrhosis. Am. J. Gastroenterol., 1999, 94 , 2988–2993.

    Said A. , 'Screening for hepatocellular carcinoma in patients with advanced cirrhosis ' (1999 ) 94 Am. J. Gastroenterol. : 2988 -2993.

    • Search Google Scholar
  • Sudaram, C., Reddy, C. R. R. M., Venkatramana, G. et al.: Hepatitis B surface antigen, hepatocellular carcinoma and cirrhosis in south India: an autopsy study. Indian J. Pathol. Microbiol., 1990, 33 , 334–338.

    Venkatramana G. , 'Hepatitis B surface antigen, hepatocellular carcinoma and cirrhosis in south India: an autopsy study ' (1990 ) 33 Indian J. Pathol. Microbiol. : 334 -338.

    • Search Google Scholar
  • Saini, N., Bhagat, A., Sharma, S. et al.: Evaluation of clinical and biochemical parameters in hepatocellular carcinoma: experience from an Indian center. Clin. Chim. Acta, 2006, 377 , 183–186.

    Sharma S. , 'Evaluation of clinical and biochemical parameters in hepatocellular carcinoma: experience from an Indian center ' (2006 ) 377 Clin. Chim. Acta : 183 -186.

    • Search Google Scholar
  • Idilman, R., De Maria, N., Colantoni, A. et al: Pathogenesis of hepatitis B and C- induced hepatocellular carcinoma. J. Viral Hepat., 1998, 5 , 285–299.

    Colantoni A. , 'Pathogenesis of hepatitis B and C- induced hepatocellular carcinoma ' (1998 ) 5 J. Viral Hepat. : 285 -299.

    • Search Google Scholar
  • De Mitri, M. S., Poussin, K., Baccarini, P. et al.: HCV-associated liver cancer without cirrhosis. Lancet, 1995, 345 , 413–415.

    Baccarini P. , 'HCV-associated liver cancer without cirrhosis ' (1995 ) 345 Lancet : 413 -415.

    • Search Google Scholar
  • Sangiovanni, A., Del Ninno, E., Fosani, P. et al.: Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance. Gastroenterology, 2004, 126 , 1005–1014.

    Fosani P. , 'Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance ' (2004 ) 126 Gastroenterology : 1005 -1014.

    • Search Google Scholar
  • Donato, F., Boffetta, P., Puoti, M.: A meta-analysis of epidemiological studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carcinoma. Int. J. Cancer, 1998, 75 , 347–354.

    Puoti M. , 'A meta-analysis of epidemiological studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carcinoma ' (1998 ) 75 Int. J. Cancer : 347 -354.

    • Search Google Scholar
  • Kubo, S., Kinoshita, H., Kuroki, T. et al.: High malignancy of hepatocellular carcinoma in alcoholic patients with hepatitis C virus. Surgery, 1997, 121 , 425–429.

    Kuroki T. , 'High malignancy of hepatocellular carcinoma in alcoholic patients with hepatitis C virus ' (1997 ) 121 Surgery : 425 -429.

    • Search Google Scholar
  • Ohnishi, K., Iida, S., Iwama, S. et al.: The effect of chronic habitual alcohol intake on the development of liver cirrhosis and hepatocellular carcinoma: Relation to hepatitis B surface carriage. Cancer, 1982, 49 , 672–627.

    Iwama S. , 'The effect of chronic habitual alcohol intake on the development of liver cirrhosis and hepatocellular carcinoma: Relation to hepatitis B surface carriage ' (1982 ) 49 Cancer : 672 -627.

    • Search Google Scholar
  • Ng, I. O., Ng, M. M., Lai, E. C. et al.: Pathologic features and patient survival in hepatocellular carcinoma in relation to age. J. Surg. Oncol., 1996, 61 , 134–137.

    Lai E. C. , 'Pathologic features and patient survival in hepatocellular carcinoma in relation to age ' (1996 ) 61 J. Surg. Oncol. : 134 -137.

    • Search Google Scholar
  • Trevisani, F., D’Intino, P. E., Grazi, G. L. et al.: Clinical and pathologic features of hepatocellular carcinoma in young and older Italian patients. Cancer, 1996, 77 , 2223–2232.

    Grazi G. L. , 'Clinical and pathologic features of hepatocellular carcinoma in young and older Italian patients ' (1996 ) 77 Cancer : 2223 -2232.

    • Search Google Scholar
  • El-Serg, H. B., Siegel, A. B., Davila, J. A., et al.: Treatment and outcomes of treating hepatocellular carcinoma among medicare recipients in the United States: A population-based study. J. Hepatol., 2006, 340 , 745–750.

    Davila J. A. , 'Treatment and outcomes of treating hepatocellular carcinoma among medicare recipients in the United States: A population-based study ' (2006 ) 340 J. Hepatol. : 745 -750.

    • Search Google Scholar
  • Nanashima, A., Masuda, J., Miuma, S. et al.: Selection of treatment modality for hepatocellular carcinoma according to the modified Japan integrated staging score. World J. Gastroenterol., 2008, 14 , 58–63.

    Miuma S. , 'Selection of treatment modality for hepatocellular carcinoma according to the modified Japan integrated staging score ' (2008 ) 14 World J. Gastroenterol. : 58 -63.

    • Search Google Scholar
  • Trevisani, F., Magini, G., Santi, V. et al.: Impact of etiology of cirrhosis on the survival of patients with hepatocellular carcinoma during surveillance. Am. J. Gastroenterol., 2007, 102 , 1022–1031.

    Santi V. , 'Impact of etiology of cirrhosis on the survival of patients with hepatocellular carcinoma during surveillance ' (2007 ) 102 Am. J. Gastroenterol. : 1022 -1031.

    • Search Google Scholar
  • Farinati, F., Marino, D., Giorgio, M. N. et al.: Diagnostic and Prognostic role of alpha fetoprotein in hepatocellular carcinoma: both or neither? Am. J. Gastroenterol., 2006, 101 , 524–532.

    Giorgio M. N. , 'Diagnostic and Prognostic role of alpha fetoprotein in hepatocellular carcinoma: both or neither? ' (2006 ) 101 Am. J. Gastroenterol. : 524 -532.

    • Search Google Scholar
  • Katyal, S., Oliver, J. H. 3rd, Peterson, M. S. et al.: Extrahepatic metastases of hepatocellular carcinoma. Radiology, 2000, 216 , 698–703.

    Oliver J. H. , 'Extrahepatic metastases of hepatocellular carcinoma ' (2000 ) 216 Radiology : 698 -703.

    • Search Google Scholar
  • Wang, B. E., Ma, W. M., Sulaiman, A. et al.: Demographic, clinical and virological characteristics of HCC in Asia: survey of 414 patients from four countries. J. Med. Virol., 2002, 67 , 394–400.

    Sulaiman A. , 'Demographic, clinical and virological characteristics of HCC in Asia: survey of 414 patients from four countries ' (2002 ) 67 J. Med. Virol. : 394 -400.

    • Search Google Scholar