Background and aims: Increasing incidence of hepatocellular carcinoma (HCC) in India is a matter of concern and need for adequate profiling and streamlining management strategies cannot be over-emphasized.
Methods: This is a prospective multi-centric observational cohort study comprising of an oncology center, one university tertiary hospital with specialized hepatology service, one public hospital with gastroenterology service, and a private liver transplant center located within a 3-km radius. The demographic and clinical parameters were recorded on a prospectively maintained database. The clinical profile, demographics, characteristics of HCC and the allocated treatment were noted and compared among the four centers.
Results: In total, 672 patients were enrolled from June 2016 till January 2020. Abdominal pain (64.3%) and weight loss (47.3%) were the most common symptoms. Most common identified etiology was hepatitis B (39%). The cancer center received lesser patients with hepatitis C and those with advanced stage of HCC. The private transplant center reported the highest proportion of NASH, which was also significantly higher in those belonging to higher socioeconomic strata, and lowest proportion of alcoholic cirrhosis. Metastasis was seen in almost one-fifth (19%) cases at diagnosis. Portal vein thrombosis was evident in 40%. Adherence to treatment guidelines was seen in three-fourth cases (76%).
Conclusions: Hepatitis B is the most common underlying cause for HCC, whereas other causes like NASH are on the rise. Etiologic profile may vary with selective specialization of centers catering to patients with HCC. Adherence to guideline while allocating treatment was high among all centers with highest non-adherence in BCLC A.
Keywords: AASLD, American Association of Study of Liver Disease; AFP, Alpha fetoprotein; ALP, Alkaline phosphatase; ALT, Alanine transaminase; AST, Aspartate transaminase; BCLC, Barcelona Clinic Liver Cancer staging; BCS, Budd Chiari syndrome; CT, Computed tomography; EASL, European Association for Study of Liver; GGT, Gamma glutamyl transpeptidase; HBV, Hepatitis B virus; HCC, Hepatocellular carcinoma; HCV, Hepatitis C virus; HKLC, Hong-Kong Liver Cancer staging; HVPG, Hepatic venous pressure gradient; INR, International normalized ratio; MDT, Multidisciplinary team; MRI, Magnetic resonance imaging; NAFLD, Non-alcoholic fatty liver disease; PHT, Portal hypertension; PVTT, Portal venous tumor thrombosis; clinical profile; hepatocellular carcinoma; milan criteria; multicenter.
© 2022 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.