الفهرس 
Epidemiology of HCCOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths worldwide, and each year, approximately 750,000 new cases are diagnosed (Jemal et al ., 2011). And approximately 690,000 people worldwide die from HCC (Ferlay et al., 2010). The number of deaths per year in HCC is virtually identical to the incidence throughout the world, underscoring the high case fatality rate of this aggressive disease (Chen et al., 2006). The aim of this study was to stage patients presenting to the National Liver Institute (NLI) with HCC, and to study the impact the staging has on treatment decisions, and the survival of patients in different stages of the disease. The study also compared the staging of patients upon presentation over the past 5 years to evaluate whether HCC patients are presenting at an earlier stage or not. This study was a retrospective-prospective study, conducted on 3122 patients who attended the HCC clinic at National Liver Institute, from January 2007 up to December 2012. Patients were classified into two groups (group A&B). All patients included in the study were subjected to: I. History taking and complete clinical examination. With special emphasis on the etiology of liver disease, history of ascites or encephalopathy and Performance status. II.laboratory investigations: - Serum Albumin, Total bilirubin, AST, ALT, INR, Creatinine, AFP, CBC.III. Ultrasound and multislice CT abdomen were done to detect: - Number of nodules. - Type (unifocal, multifocal, diffuse). - Maximum tumor diameter (cm) - Location (right/left/both lobes) - Portal vein thrombosis - Extra hepatic or lymph node metastasis - Splenomegaly IV. Child-Turcotte-Pugh (CTP was determined. V. Staging of the tumor was determined at the time of HCC diagnosis using the BCLC and CLIP staging systems. VI. All patients’ data were reviewed by a multidisciplinary team and the best suitable treatment was recommended for the patients according to the international guidelines. Patients were followed up from the time of diagnosis to the date of death or date of data collection if they remained alive. Overall survival and received treatment were determined. It was found that: 1. The mean age of the HCC patients was 58.3 years. 2. Male was the predominant gender of HCC patients. 3. About 52.7% of the HCC patients were smokers. 4. About 12.4% of the HCC patients were diabetics. 5. Most of the HCC patients were HCV Ab +ve and few percentages had HBs Ag +ve. 6. Most of patients had performance status of 1 (PS1) followed by PS0. 7. Most of the patients attended the HCC clinic were Child A following them Child B patients. 8. Portal vein thrombosis was found in 16.2%of patients. 9. Metastasis was found in 8.2% of patients. 10. Most of patients had uninodular lesion especially in right lobe. 11. Most of the patients had score 1, the least had score 5 of CLIP staging. 12. The median survival times of patients with CLIP scores of 2, 3, 4, 5, 6 were 17, 9, 9, 12, 2 months respectively. 13. There was a significant difference in survival across the different stages of CLIP (p value <0.001). 14. 64 % of patients presented in early and intermediate stages BCLC A and BCLC B. 15. The mean survival time was 34.3, 30.2 month for BCLC A and BCLC B respectively and the difference was statistically not significant. 16. The median survival of BCLC stage C was 9.1 month which was statistically significant compared to BCLC B. 17. For BCLC D the median survival time was 10.2 which was statistically not significant compared to BCLC C. 18. BCLC recommendations were applied in 57% of cases in our center. 19. Thirty-seven per cent of the patients included in early stage received curative treatment. 20. In stage A, 109 patients were treated according to BCLC recommendations, hepatic resection in 19 patients, liver transplantation in 21 patients, RFA in 53 patients and Microwave in 4 patients, PEI in 3 patients, combined therapy (RFA and TACE) in 9 patients. A number of 14 patients, were undertreated (20 received supportive care and 30 was treated with TACE and one patient received systemic chemotherapy). 21. In stage B, TACE was done for 186 patients and combined TACE, RFA in 4 patients. Over treatment done for 5 patients as resection for 2 patients, RFA for 2 patients and PEI for one patient. 36 patients were undertreated (35 received supportive care and one was treated with chemotherapy). 22. In stage C, 38 patients treated with sorafenib according to BCLC recommendation. over treatment done for 13 patients as resection for 2 patients, RFA for one patients, TACE for 10 patients. 188 patients were undertreated (184 received supportive care and 3 patients were treated with systemic chemotherapy and one patient with radiotherapy. 23. In stage D, 104 patients were treated according to BCLC indication. Supportive care was done for 93 patients and over treatment was done for 8 patients as 5 patients undergone liver transplantation, TACE was done for 2 patients and one patient received sorafenib. 24. Forty three per cent of the patients from our group were not treated according to BCLC recommendations, 4% of patients were overtreated and 39% were undertreated, most of the deviations occurring in stage C and A . 25. Regarding the CLIP system 7.3%, 18.4 % of patients in group A and B respectively were classified under CLIP score 4-6. 26. BCLC staging was statistically significant when compared both groups with distribution of 26%, 39%, 26%, 9%in groupA compared to 25 %, 30%, 20%, and 25% of group B. 27. About 56 % of patient in group B presented in early and intermediate stages (stage A, B), 44% in advanced and terminal stages (stages C, D) compared to 65%, and 35% for stages A, B and C, D respectively in group A which was statistically significant . 28. Regards the JIS staging most of patients presented mainly with score 1, 2, and 3 in group A compared to score 2, 3, and 4 in group B which was statistically significant The Child Pugh score of group 2, child A, B were equal and near to 25% of patients presented with child C compared to group 1 where A was 56% and very small number with C which is statically significant. 29. Regarding Child Pugh score nearly 25% of patients presented with CTP C in group B compared to group A where very small number presented with CTP C which was statistically significant. 30. About half of the patients in group A were found Okuda stage I (49.2%) while 45.9% of group B were found Okuda stage II which was statistically significant.