QJM Advance Access published online on April 24, 2008
QJM, doi:10.1093/qjmed/hcn033
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Characteristics of hepatocellular carcinoma in India: a retrospective analysis of 191 cases
From the 1Department of Hepatology, Institute of Liver and Biliary Sciences and 2Departments of Gastroenterology and Pathology, G.B. Pant Hospital, Delhi, India
Address correspondence to Dr S.K. Sarin, Professor and Head, Department of Gastroenterology, Room No. 201, 2nd Floor, Academic Block, G.B. Pant Hospital, New Delhi, 110002, India. email: sksarin{at}nda.vsnl.net.in
Received 13 October 2007 and in revised form 21 February 2008
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Abstract |
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Background: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. The outcome of the disease is related to the stage of presentation. A comprehensive analysis of patients with this disease is not available in India.
Methods: Retrospective chart review of 246 patients with HCC was done. One hundred ninety-one patients (male 160, female 31; median age 52 years, range 9–85 years) fulfilling diagnostic criteria for HCC adopted by Barcelona-2000 EASL conference were analyzed for clinical, etiological, radiological and cytohistological profile.
Results: Underlying cirrhosis was seen in 60% cases with hepatitis B being the most common etiologic agent. HCC caused new onset ascites and recent worsening in three-fourth cases with ascites. Paraneoplastic syndrome was a rare event in HCC in India. Diagnostic level of serum AFP was seen in only 46% with significant difference between cirrhosis HCC patients compared with non-cirrhosis HCC patients (53% vs. 26%; P = 0.046). Most cases (83%) presented at advanced stage (Okuda III or IV) and cytohistology was the best method to diagnose HCC. Vascular invasion was seen in half the patients (53%) by the time they presented with extrahepatic spread of tumor in 13% cases.
Conclusions: The prevalence of advanced stage HCC makes most of the detectable lesions unsuitable for curative resection. However, universal hepatitis B vaccination program may become the most effective preventive measure to control this disease in India.