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Abstract
Hepatobiliary cancers are considered as a major health problem worldwide. They include (hepatocellular carcinoma; HCC), gall bladder, and bile ducts (intrahepatic and extrahepatic cholangiocarcinoma).
HCC is one of the most common malignancies associated with poor prognosis. The incidence of HCC has increased sharply in the last 5-10 years. In Egypt, there has been a remarkable increase of the proportion of HCC among patients with chronic liver diseases. This rising proportion may be explained by the increasing risk factors such as the emergence of HCV infection, the contribution of HBV infection, improvement of the screening programs and diagnostic tools of HCC, as well as the increased survival rate among patients with cirrhosis to allow time for some of them to develop HCC.
Biliary tract cancers include cancer of the gallbladder, the bile ducts, and the ampulla of Vater. Worldwide, there is a prominent geographic variability in gall bladder cancer (GBC) incidence that correlates with the prevalence of cholelithiasis. High rates of GBC are seen in South American countries. In the United States, GBC is the most common cancer arising in the biliary tract and the fifth most common gasterointestinal cancer. Obstructive jaundice is the most common presentation for biliary tract cancers.
In the present study data from the medical records of 527 Hepatocellular cancer patients and 57 biliary tract cancer ones presented to Alexandria Clinical Oncology Department (ACOD) from January 2003 to December 2012 were collected and retrospectivaly reviewed for the clinicopathological features that included (patient’s age and sex, associated comorbidities, smoking habits, history of viral hepatitis, documented laboratory and radiological investigations, pathological criteria of the tumor, Child Pugh classification, staging of the disease according to BCLC system and AJCC 7th edition 2010 guidelines, treatment modalities and survival outcomes (overall survival and progression free survival)).
In accordance to our results for HCC patients, the mean age at diagnosis was about 57.08 ± 8.91 (ranged from 23 – 85 years). About 74.6% of the studied HCC patients were males while 25.4% were females and 57.7% were smokers, while 38.3% were non- smokers.
About 98.2% of the studied HCC patients were HCV +ve, while only 1% were HBV +ve and only 0.8% had negative viral markers. The majority of the studied HCC patients were child B (46.1%) with 18.2% as B/7, 19.2% as B/8 and 8.7% as B/9 followed by 19.4% as child C then 17.2% as child A with 4.7% as A/5 and 12.5% as A/6. This study showed that about 26.3% of the studied HCC patients had AFP <200 ng/mL and 73.7% had AFP ≥200 ng/mL.Different items were analyzed in this study as PVT,number of hepatic focal lesions, viral hepatitis,state of metastasis and different treatment modalitis received by the studied HCC patients as surgery,local treatment (TACE,RFA) and also systemic treatment (chemotherapy and supporitive treatment),all were correlated with survival outcomes (OS &PFS).
Hepatobiliary cancers are considered as a major health problem worldwide. They include (hepatocellular carcinoma; HCC), gall bladder, and bile ducts (intrahepatic and extrahepatic cholangiocarcinoma).
HCC is one of the most common malignancies associated with poor prognosis. The incidence of HCC has increased sharply in the last 5-10 years. In Egypt, there has been a remarkable increase of the proportion of HCC among patients with chronic liver diseases. This rising proportion may be explained by the increasing risk factors such as the emergence of HCV infection, the contribution of HBV infection, improvement of the screening programs and diagnostic tools of HCC, as well as the increased survival rate among patients with cirrhosis to allow time for some of them to develop HCC.
Biliary tract cancers include cancer of the gallbladder, the bile ducts, and the ampulla of Vater. Worldwide, there is a prominent geographic variability in gall bladder cancer (GBC) incidence that correlates with the prevalence of cholelithiasis. High rates of GBC are seen in South American countries. In the United States, GBC is the most common cancer arising in the biliary tract and the fifth most common gasterointestinal cancer. Obstructive jaundice is the most common presentation for biliary tract cancers.
In the present study data from the medical records of 527 Hepatocellular cancer patients and 57 biliary tract cancer ones presented to Alexandria Clinical Oncology Department (ACOD) from January 2003 to December 2012 were collected and retrospectivaly reviewed for the clinicopathological features that included (patient’s age and sex, associated comorbidities, smoking habits, history of viral hepatitis, documented laboratory and radiological investigations, pathological criteria of the tumor, Child Pugh classification, staging of the disease according to BCLC system and AJCC 7th edition 2010 guidelines, treatment modalities and survival outcomes (overall survival and progression free survival)).
In accordance to our results for HCC patients, the mean age at diagnosis was about 57.08 ± 8.91 (ranged from 23 – 85 years). About 74.6% of the studied HCC patients were males while 25.4% were females and 57.7% were smokers, while 38.3% were non- smokers.
About 98.2% of the studied HCC patients were HCV +ve, while only 1% were HBV +ve and only 0.8% had negative viral markers. The majority of the studied HCC patients were child B (46.1%) with 18.2% as B/7, 19.2% as B/8 and 8.7% as B/9 followed by 19.4% as child C then 17.2% as child A with 4.7% as A/5 and 12.5% as A/6. This study showed that about 26.3% of the studied HCC patients had AFP <200 ng/mL and 73.7% had AFP ≥200 ng/mL.Different items were analyzed in this study as PVT,number of hepatic focal lesions, viral hepatitis,state of metastasis and different treatment modalitis received by the studied HCC patients as surgery,local treatment (TACE,RFA) and also systemic treatment (chemotherapy and supporitive treatment),all were correlated with survival outcomes (OS &PFS).
Absence of PVT, small sized hepatic focal lesions and non metastatic HCC patients were correlated with significant OS and PFS with P value <0.001.Regarding local treatment (Surgery, TACE and RFA ), they were associated with significant OS and PFS