Introduction
Hepatocellular Carcinoma is One of the highest incidence among all hepatic malignancies. Most HCC cases occur in patients with underlying liver disease. HCC is the second most frequent cancer in men and the sixth most frequent cancer in women in Egypt where post HCV-related cirrhosis is the most common cause.
Aims & Methods
This is a retrospective record-based analysis of prospectively collected data done in the Tropical Medicine Department, Mansoura University Hospital, Egypt covering the 10 years period. It included all HCC patients who received treatment during the period from 2011 to2020. Patients with hepatic tumor other than HCC , or missed follow up were excluded. A total of 202 out of 715 HCC patients (28.3%) were included in the studywas elgible for Loco regional treatment according to Barcelona clinic of liver cancer in the form of Radiofrequency (RF),tranansarterialchemoembolization(TACE)and Microwaveablation (MWA). Modified Response Evaluation Criteria In Solid Tumors(mRIST) and Hepatoma Arterial-embolisation Prognostic (HAP) Score were applied in this study
Results
This study included 202 patients with age ranging from 42 to 81 years with a mean of 58.8 ± 7.1 years. The duration of follow-up ranged from 11 to 132 months with a mean 37.9 ± 15.6 months and a median of 36 months. All cases was post HCV related cirrhosis. At the start of the study 33.7% received no locoregional treatment, while 41.5%, 41.6%, 0.03,%, 0.05% and 15.34% undergo TACE,MWA,RF,and multiple interventions respectively while at the end of the study 70.3%,19.3% and 10.4% undergo TACE, MWA and RF respectively
According to mRIST the complete response, partial response, stationary and progressive course accounted for 48.5%, 46.0%, 0.99% and 4.45%; respectively.
The overall complete response was 48.5%. The complete response is significantly higher in females (CRR=2.0), CHILD A5 (CRR=2.4), BCBC (CRR=4.2), single nodule (CRR=5.1), nodule size of <2 and 2 to <3 (CRR=6.1 and 8.1; respectively), AFP <400 (CRR=6.3), HAP score 1and treated HCV (CRR=3.2 and 4.4; respectively)and treatment with MWA and RF (CRR=6.1 and 11.0; respectively).
The independent predictors of complete response are BCLC of 0 & A (ARR=2.6), Single nodule (ARR=3.8), nodule size of <2 and 2-<3 (ARR=4.7 and 8.0; respectively), AFP<400 (ARR=7.7) and cured past hepatitis (ARR=4.4).( NB:CRR= crude relative risk ,ARR= adjusted relative risk)
the overall mean survival is 49.9 months. The mean overall survival is significantly longer in age ≤60 years, males, BCLC of 0 & A, single node affection, AFP <400, Previous treatment with MWA and HAPscore (0 & 1) P< 0.001).
The overall mean progression free survival (PFS) is 19.4 months. The mean PFS is significantly longer in BCLC of B & C ,HAP (0&1) and single node affection P<0.005).
The cox regression analysis revealed that the independent predictors of overall survival are age >60 years (HR=0.6), BCLC B&C (HR=2.3) and multiple nodes affection (HR=0.1) while the independent predictor of PFS is multiple nodes affection (HR=0.4).
Conclusion
The complete response and the over all survival (mean49.4 months) were significantly higher in younger age .early child score, early staging, HAP score (0&1) AFP<400 and treatment with MWA. The overall mean progression free survival (PFS) is 19.4 months. The mean PFS is significantly longer in BCLC of B & C, HAP (0&1) and single node affection.
Disclosure
No conflict of interest to be diclosed