Hepatocellular carcinoma in Native South Asian Pakistani population; trends, clinico-pathological characteristics & differences in viral marker negative & viral-hepatocellular carcinoma

BMC Research Notes

Wasim Jafri⁵  Tanveer Ul Haq¹  Bilal Ahmed³  Omer Farooq³  Ammar Asrar Javed²  Mariam Ghufran⁴  Ashfaq Ahmad Wadalawala⁵  Saeed Hamid⁵  Amna Subhan Butt⁵ 

[1] Department of Radiology, The Aga Khan University, Karachi, Pakistan;The Aga Khan University, Karachi, Pakistan;Department of Medicine, The Aga Khan University, Karachi, Pakistan;Department of Family Medicine, The Aga Khan University, Karachi, Pakistan;Section of Gastroenterology, Department of Medicine, The Aga Khan University & Hospital, Stadium Road, Karachi 74800, Pakistan

关键词: Pakistan;    Hepatitis C;    Hepatitis B;    Viral-HCC;    Viral marker negative HCC;    Hepatocellular Carcinoma;   

Others  :  1142967
DOI  :  10.1186/1756-0500-6-137

 received in 2012-02-13, accepted in 2013-03-20,  发布年份 2013

【 摘 要 】

Background

HCC is the fifth most common cancer globally. Our study was conducted to (1)investigate the trends and clinico-pathological characteristics of Hepatocellular carcinoma among native South Asian patients in Pakistan, (2)to estimate the prevalence as well as the trends of viral marker negative HCC and (3) to compare the clinico-pathological, radiological characteristics, applicability of treatment at diagnosis and prognostic factors among patients with both viral marker negative and viral marker positive-HCC being consulted at Aga Khan University Hospital(AKUH), Karachi, Pakistan.

Method

Patients ≥18 years, already diagnosed to have HCC and visiting AKUH during 1999–2009 were identified using ICD code 1550. The diagnosis of HCC was made in the presence of characteristic features of HCC on triple-phasic CT scan/MRI or with histological findings on biopsy.

Results

645 patients were enrolled. Of these 546(84.7%) were viral-HCC and 99(15.3%) were viral marker negative HCC. Among viral-HCC group underlying etiology of cirrhosis was HCV in 67.9%, HBV in 21.8% and concomitant HBV with HCV or HDV in 10.3% cases. Majority (62.8%) patients had advanced HCC. Larger tumor size (p < 0.001), shorter duration between diagnosis of cirrhosis and HCC (p 0.03), concomitant Diabetes Mellitus (p < 0.001) were found significant factors associated with viral marker negative HCC.

Conclusion

The burden of hepatocellular carcinoma is rising among native South Asian Pakistani population and the viral marker negative HCC are not uncommon in our population. Viral marker negative HCC tend not to be under surveillance as compared to viral-HCC and are diagnosed mostly at advanced stage & when they became symptomatic.

【 授权许可】

   
2013 Butt et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Bruix JSM: Management of Hepatocellular Carcinoma: An Update. Hepatology 2010, 00(00):1-35.
• [2]Raza SA, Clifford GM, Franceschi S: Worldwide variation in the relative importance of hepatitis B and hepatitis C viruses in hepatocellular carcinoma: a systematic review. Br J Cancer 2007, 96(7):1127-1134.
• [3]Toyoda H, Kumada T, Kiriyama S, Sone Y, Tanikawa M, Hisanaga Y, Kanamori A, Yamaguchi A, Isogai M, Kaneoka Y: Characteristics and prognosis of patients in Japan with viral marker-negative hepatocellular carcinoma. J Gastroenterol Hepatol 2008, 23(3):459-466.
• [4]Liu CJ, Kao JH: Hepatitis B virus-related hepatocellular carcinoma: epidemiology and pathogenic role of viral factors. J Chin Med Assoc 2007, 70(4):141-145.
• [5]Dohmen K, Shigematsu H, Irie K, Ishibashi H: Comparison of the clinical characteristics among hepatocellular carcinoma of hepatitis B, hepatitis C and non-B non-C patients. Hepatogastroenterology 2003, 50(54):2022-2027.
• [6]Noguchi K, Nakashima O, Nakashima Y, Shiota K, Nawata H, Kojiro M: Clinicopathologic study on hepatocellular carcinoma negative for hepatitis B surface antigen and antibody to hepatitis C virus. Int J Mol Med 2000, 6(6):661-665.
• [7]Koike Y, Shiratori Y, Sato S, Obi S, Teratani T, Imamura M, Hamamura K, Imai Y, Yoshida H, Shiina S: Risk factors for recurring hepatocellular carcinoma differ according to infected hepatitis virus-an analysis of 236 consecutive patients with a single lesion. Hepatology 2000, 32(6):1216-1223.
• [8]Wands JR: Prevention of hepatocellular carcinoma. N Engl J Med 2004, 351(15):1567-1570.
• [9]Iizuka N, Oka M, Yamada-Okabe H, Hamada K, Nakayama H, Mori N, Tamesa T, Okada T, Takemoto N, Matoba K: Molecular signature in three types of hepatocellular carcinoma with different viral origin by oligonucleotide microarray. Int J Oncol 2004, 24(3):565-574.
• [10]Benvegnu L, Alberti A: Patterns of hepatocellular carcinoma development in hepatitis B virus and hepatitis C virus related cirrhosis. Antiviral Res 2001, 52(2):199-207.
• [11]Yang HI, Lu SN, Liaw YF, You SL, Sun CA, Wang LY, Hsiao CK, Chen PJ, Chen DS, Chen CJ: Hepatitis B e antigen and the risk of hepatocellular carcinoma. N Engl J Med 2002, 347(3):168-174.
• [12]Cantarini MC, Trevisani F, Morselli-Labate AM, Rapaccini G, Farinati F, Del Poggio P, Di Nolfo MA, Benvegnu L, Zoli M, Borzio F: Effect of the etiology of viral cirrhosis on the survival of patients with hepatocellular carcinoma. Am J Gastroenterol 2006, 101(1):91-98.
• [13]Hatanaka K, Kudo M, Fukunaga T, Ueshima K, Chung H, Minami Y, Sakaguchi Y, Hagiwara S, Orino A, Osaki Y: Clinical characteristics of NonBNonC- HCC: Comparison with HBV and HCV related HCC. Intervirology 2007, 50(1):24-31.
• [14]Adams PC, Arthur MJ, Boyer TD, DeLeve LD, Di Bisceglie AM, Hall M, Levin TR, Provenzale D, Seeff L: Screening in liver disease: report of an AASLD clinical workshop. Hepatology 2004, 39(5):1204-1212.
• [15]Khokhar N, Aijazi I, Gill ML: Spectrum of hepatocellular carcinoma at Shifa International Hospital. Islamabad. J Ayub Med Coll Abbottabad 2003, 15(4):1-4.
• [16]Sharieff S, Burney KA, Ahmad N, Salam A, Siddiqui T: Radiological features of hepatocellular carcinoma in Southern Pakistan. Trop Doct 2001, 31(4):224-225.
• [17]Abdul Mujeeb S, Jamal Q, Khanani R, Iqbal N, Kaher S: Prevalence of hepatitis B surface antigen and HCV antibodies in hepatocellular carcinoma cases in Karachi. Pakistan. Trop Doct 1997, 27(1):45-46.
• [18]Tong CY, Khan R, Beeching NJ, Tariq WU, Hart CA, Ahmad N, Malik IA: The occurrence of hepatitis B and C viruses in Pakistani patients with chronic liver disease and hepatocellular carcinoma. Epidemiol Infect 1996, 117(2):327-332.
• [19]Hussain K, El-Serag HB: Epidemiology, screening, diagnosis and treatment of hepatocellular carcinoma. Minerva Gastroenterol Dietol 2009, 55(2):123-138.
• [20]Bruix J, Sherman M: Management of hepatocellular carcinoma. Hepatology 2005, 42(5):1208-1236.
• [21]Shaheen AA, Myers RP: Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C-related fibrosis: a systematic review. Hepatology 2007, 46(3):912-921.
• [22]Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R: Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973, 60(8):646-649.
• [23]Dohmen K: Many staging systems for hepatocellular carcinoma: evolution from Child-Pugh. Okuda to SLiDe. J Gastroenterol Hepatol 2004, 19(11):1227-1232.
• [24]Trevisani F, De NS, Rapaccini G, Farinati F, Benvegnu L, Zoli M, Grazi GL, Del PP, Di N, Bernardi M: Semiannual and annual surveillance of cirrhotic patients for hepatocellular carcinoma: effects on cancer stage and patient survival (Italian experience). Am J Gastroenterol 2002, 97(3):734-744.
• [25]Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, Ammatuna M, Morabito A, Gennari L: Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996, 334(11):693-699.
• [26]Llovet JM, Fuster J, Bruix J: The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl 2004, 10(2 Suppl 1):S115-120.
• [27]Hosmer DW: LS: Applied Logistic regression. New York: Wiley and Sons; 1989.
• [28]Nagaoki Y, Hyogo H, Aikata H, Tanaka M, Naeshiro N, Nakahara T, Honda Y, Miyaki D, Kawaoka T, Takaki S: Recent trend of clinical features in patients with hepatocellular carcinoma. Hepatol Res 2012, 42(4):368-375.
• [29]Sharieff S, Burney I, Salam ATS: Hepatocellular Carcinoma. J Coll Physicians Surg Pak 2002, 12(5):264-267.
• [30]Mumtaz MSIR, Umar M, Khar B, Mumtaz MO, Anwar F, Zulfiqar S, Ejaz S, Hanif S, Khan MA, Mazhar S, Abassi S: Sero-Prevalence of Hepatitis B and C Viruses in Hepatocellular Carcinoma. J Rawal Med Coll 2001, 5(2):78-80.
• [31]Marrero JA, Fontana RJ, Su GL, Conjeevaram HS, Emick DM, Lok AS: NAFLD may be a common underlying liver disease in patients with hepatocellular carcinoma in the United States. Hepatology 2002, 36(6):1349-1354.
• [32]Davila JA, Morgan RO, Shaib Y, McGlynn KA, El-Serag HB: Hepatitis C infection and the increasing incidence of hepatocellular carcinoma: a population-based study. Gastroenterology 2004, 127(5):1372-1380.
• [33]Seeff LB, Hoofnagle JH: Epidemiology of hepatocellular carcinoma in areas of low hepatitis B and hepatitis C endemicity. Oncogene 2006, 25(27):3771-3777.
• [34]Akahoshi H, Taura N, Ichikawa T, Miyaaki H, Akiyama M, Miuma S, Ozawa E, Takeshita S, Muraoka T, Matsuzaki T: Differences in prognostic factors according to viral status in patients with hepatocellular carcinoma. Oncol Rep 2010, 23(5):1317-1323.
• [35]Trevisani F, Magini G, Santi V, Morselli-Labate AM, Cantarini MC, Di Nolfo MA, Del Poggio P, Benvegnu L, Rapaccini G, Farinati F: Impact of etiology of cirrhosis on the survival of patients diagnosed with hepatocellular carcinoma during surveillance. Am J Gastroenterol 2007, 102(5):1022-1031.
• [36]Wakai T, Shirai Y, Yokoyama N, Nagakura S, Hatakeyama K: Hepatitis viral status affects the pattern of intrahepatic recurrence after resection for hepatocellular carcinoma. Eur J Surg Oncol 2003, 29(3):266-271.
• [37]Miyazawa K, Moriyama M, Mikuni M, Matsumura H, Aoki H, Shimizu T, Yamagami H, Kaneko M, Shioda A, Tanaka N: Analysis of background factors and evaluation of a population at high risk of hepatocellular carcinoma. Intervirology 2003, 46(3):150-156.