Clinical characteristics of patients with hepatocellular carcinoma hospitalized in tertiary care hospital

Zadnjih nekoliko godina incidencija hepatocelularnog karcinoma (HCC) je u porastu. Cilj ove studije bio je utvrditi stadij bolesti u trenutku postavljanja dijagnoze kod hrvatskih bolesnika s HCC-om te na temelju dobivenih podataka utvrditi postoje li potrebe i mogućnosti poboljšanja dijagnostike u cilju ranijeg otkrivanja HCC-a, a time i boljih mogućnosti liječenja. Retrospektivno su analizirani demografski podaci bolesnika s HCC-om obrađivanih u 2 klinička centra (KBC Split i KB Dubrava), etiologija bolesti (alkohol, NAFLD, HBV, HCV), stadij HCC-a prema Milanskim i Barcelona-Clinic Liver cancer (BCLC) kriterijima uključujući i stanje jetrene funkcije prema Child-Pugh (CP) klasifikaciji, vrijednosti tumorskog biljega AFP i performans status bolesnika prema ECOG klasifikaciji. Rezultati su uspoređeni s podatcima o stadijima HCC-a u zemljama EU i SAD prema procjenama Europskog udruženja za bolesti jetre (EASL). U istraživanje je uključeno 137 bolesnika (108 muškaraca i 29 ţena), prosječne dobi 68,03 godine (27-86). Svi bolesnici imali su cirozu i to 71 (51,8%) bolesnik CP A stadij, 44 (32,1%) bolesnika CP B i 22 (16,1%) bolesnika CP C. Etiološki, alkoholnu bolest jetre imalo je 87 (63,5%) pacijenata, NAFLD 10 (7,3%), HBV 12 (8,75%), HCV 5 (3,65%), dok je nepoznatu etiologiju imalo 23 (16,8%) pacijenta. Medijan ukupne veličine tumora (TTD) iznosio je 85 mm (11-290). Unutar Milanskih kriterija bilo je 48 (35%), a izvan 89 (65%) pacijenata. Ekstrahepatičke metastaze imalo je 30 (21,9%) pacijenata, a infiltraciju krvnih ţila 35 (25,5%). AFP je bio povišen samo kod 68 (33,62%) od 113 pacijenata kod kojih je mjeren i to uglavnom kod uznapredovalog HCC-a, a medijan AFP-a je iznosio 432 ng/ml (10,4-175000). ECOG status 0 imalo je 4 (2,92%), ECOG 1- 34 (24,82%), ECOG 2-48 (35,04%), ECOG 3- 24 (17,52%), a ECOG 4- 27 (19,7%) pacijenata. Prema ovim podacima pacijenti su svrstani u BCLC stadije na sljedeći način: BCLC A- 26 (19%), BCLC B- 49 (35,8%), BCLC C- 40 (29,2%), a BCLC D- 22 (16,1%). Uspoređujući naše podatke sa procjenama EASL-a moţe se zaključiti da se rani stadij HCC-a (izlječiva bolest) u Hrvatskoj dijagnosticira u svega 19% bolesnika što je dvostruko lošije u odnosu na očekivanja prema europskim smjernicama. Potrebno je poduzeti korake na upoznavanju javnosti s rizičnim čimbenicima za nastanak bolesti jetre i HCC-a te poboljšati otkrivanje ranog HCC-a i time povećati mogućnosti izlječenja.During recent years the incidence of hepatocellular carcinoma (HCC) has been increasing. The purpose of this study was to determine the stage of disease at the moment of the diagnosis in Croatian patients with HCC and, based on the data, to determine whether there are needs and possibilities to improve diagnostics in order to detect HCC earlier and therefore have better treatment options.We retrospectively analyzed demographic data of patients with HCC who were processed in two clinical centers (KBC Split and KB Dubrava), etiology (alcohol, NAFLD, HBV, HCV), stage of HCC according to the Milan and Barcelona Clinic Liver Cancer (BCLC ) criteria including the status of liver function according to Child-Pugh (CP) classification, level of tumor marker AFP and the ECOG performance status. Results were compared with data of HCC stages in the EU and the United States estimated by the European Association for Liver Disease (EASL).The study included 137 patients (108 men and 29 women), average age of 68.03 years (27-86), who were diagnosed with HCC. All patients had cirrhosis and 71 (51.8%) patients were in CP A stage, 44 (32.1%) patients in CP B and 22 (16.1%) patients in CP C stage. Etiologically, alcoholic liver disease had 87 (63.5%) patients, NAFLD 10 (7.3%), HBV 12 (8.75%), HCV 5 (3.65%), while 23 (16,8%) patients had unknown etiology. Median TTD was 85 mm (11-290). Within the Milan criteria were 48 (35%), and out of the Milan criteria 89 (65%) patients. Extrahepatic metastases had 30 (21.9%) patients, and the vascular infiltration 35 (25.5%). AFP was increased in only 68 (33.62%) out of 113 patients mostly with advanced HCC and the median AFP was 432 ng / ml (10.4 -175,000). ECOG preformance status 0 had 4 (2.92%) patients, ECOG 1- 34 (24.82%), ECOG 2-48 (35.04%), ECOG 3- 24 (17.52%), and ECOG 4- 27 (19.7%) patients. According to these data, the patients were classified in BCLC stages as follows: BCLC A-26 (19%), BCLC B- 49 (35.8%), BCLC C-40 (29.2%), and BCLC D-22 ( 16.1%) patients. Comparing our data with estimates of EASL, it can be concluded that the early stage of HCC (curable) in Croatia is diagnosed in only 19% of patients, which is two times worse than expected according to European guidelines. It is necessary to take steps to raise public awareness of risk factors for the development of liver diseases and HCC as well as improve the detection of early HCC and thus increase the possibility of healing