Abstract
Background: HCC is a dismal tumor with a high incidence, prevalence and poor prognosis & survival. Management necessitates multidisciplinary clinics due wide heterogeneity in presentation, different therapeutic options, and variable biologic behavior especially with background of chronic liver disease.
Patients and Methods: In a specialized HPB clinic in Assuit university Hospital, and Sohag University hospital. We studied different types of patient and tumor characteristics with evaluation of the surgical management applied to them. Further analysis was performed using univariate and multivariate statistics.
Results: From December 2000 till March 2014, 220 patients with HCC presented to our clinics, were predominantly males (mean age 56 years), mostly with cirrhosis due to HCV (71%), as Child-Pugh A (52%) or B (32%) and with single lesion. Transarterial chemoembolization was the commonest treatment (32.4%), followed by ablation therapy (27%). A major section was palliatively treated due to delayed discovery and advanced stage of disease (63%); resection was the standard in operable cases (25.4%). Non-anatomic resection was commonly done in 58%, however other techniques were used as anatomic resection (27%), and laparoscopic resection (15%), unfortunately, transplantation program does not started yet to be added. The overall survival was 80% at 6 months, 55% at 1 year and 20% at 2 years. Serum bilirubin, portal hypertension, site of the tumor and type of treatment were the significant independent prognostic factors for survival.
Conclusions: early discovery by surveillance protocols is very essential for better outcome, early interference weather by surgery or ablation is a good substitute in absence of transplantation programs. Our main prognostic variables are the bilirubin level, portal hypertension, the bilobar affection and the application of specific treatment curative or palliative. Multidisciplinary clinics enhance better HCC management.