Multi-center prospective survey of hepatocellular carcinoma in Kerala: More than 1,200 cases.

Male Humans Female Carcinoma, Hepatocellular / epidemiology Liver Neoplasms / epidemiology Non-alcoholic Fatty Liver Disease / epidemiology Prospective Studies Chemoembolization, Therapeutic Surveys and Questionnaires Treatment Outcome Retrospective Studies

Alcohol Cancer Diabetes mellitus Epidemiology Fatty liver Hypertension Liver Metastasis Neoplasm Obesity Survival

Journal

Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology

ISSN: 0975-0711

Titre abrégé: Indian J Gastroenterol

Pays: India

ID NLM: 8409436

Informations de publication

Date de publication:
04 2023

Historique:

received: 24 03 2022

accepted: 22 11 2022

medline: 15 6 2023

pubmed: 8 5 2023

entrez: 8 5 2023

Statut: ppublish

Résumé

Hepatocellular carcinoma (HCC) is considered uncommon in India. The aim of this study was to document the demographic characteristics and clinical aspects of HCC in Kerala, India. A survey of HCC in Kerala was performed. All gastroenterologists in the region were invited. From May 2018 to April 2020, data was collected in a standardized questionnaire. Forty-three doctors from 15 centers contributed the data. Total 1217 patients were analyzed. This is the largest state-wide survey of HCC in India. HCC was more common in men (90%) than in women (p < 0.01). The etiology of liver disease was hepatitis B virus (7%), hepatitis C virus (4%) and alcohol (40%). Diabetes mellitus was present in 64%, hypercholesterolemia in 17% and hypertension in 38%. Obesity was present in 33% and 15% were overweight. Non-alcoholic fatty liver disease (NAFLD) with or without metabolic syndrome was present in 44%. Serum alpha-fetoprotein was > 400 ng/mL in 24%, total tumor diameter was > 5 cm in 59%, portal vein invasion was seen in 35% and distant metastasis was seen in 15%. Specific therapy was given to 52%. Treatments given included liver transplantation (n = 24), liver resection (n = 39) and transarterial chemoembolization (TACE, n = 184). Although the study was not designed to compare survival, patients who had liver transplantation had longer survival (median 69 months) compared to matched patients given only TACE (median 18 months) (p = 0.03). HCC is common in Kerala, India. NAFLD has a predominant association with HCC in Kerala. Most of the patients report late when curative treatment is not possible.

Sections du résumé

BACKGROUND

Hepatocellular carcinoma (HCC) is considered uncommon in India. The aim of this study was to document the demographic characteristics and clinical aspects of HCC in Kerala, India.

METHODS

A survey of HCC in Kerala was performed. All gastroenterologists in the region were invited. From May 2018 to April 2020, data was collected in a standardized questionnaire.

RESULTS

Forty-three doctors from 15 centers contributed the data. Total 1217 patients were analyzed. This is the largest state-wide survey of HCC in India. HCC was more common in men (90%) than in women (p < 0.01). The etiology of liver disease was hepatitis B virus (7%), hepatitis C virus (4%) and alcohol (40%). Diabetes mellitus was present in 64%, hypercholesterolemia in 17% and hypertension in 38%. Obesity was present in 33% and 15% were overweight. Non-alcoholic fatty liver disease (NAFLD) with or without metabolic syndrome was present in 44%. Serum alpha-fetoprotein was > 400 ng/mL in 24%, total tumor diameter was > 5 cm in 59%, portal vein invasion was seen in 35% and distant metastasis was seen in 15%. Specific therapy was given to 52%. Treatments given included liver transplantation (n = 24), liver resection (n = 39) and transarterial chemoembolization (TACE, n = 184). Although the study was not designed to compare survival, patients who had liver transplantation had longer survival (median 69 months) compared to matched patients given only TACE (median 18 months) (p = 0.03).

CONCLUSION

HCC is common in Kerala, India. NAFLD has a predominant association with HCC in Kerala. Most of the patients report late when curative treatment is not possible.

Identifiants

DOI: 10.1007/s12664-022-01314-8 PMID: 37154853

pubmed: 37154853

doi: 10.1007/s12664-022-01314-8

pii: 10.1007/s12664-022-01314-8

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

233-240

Investigateurs

Sunil K Mathai (SK)

Mathew Jacob (M)

K G Sabu (KG)

M Ramesh (M)

Noushif Medappil (N)

A Shanid (A)

Jeffey George (J)

Harikumar R Nair (HR)

Shelley C Paul (SC)

Mathew J Chooracken (MJ)

John Mathew (J)

Siljo Jose (S)

Shaji Ponnambathayil (S)

R Nandakumar (R)

P Maya (P)

Jeesemon Joseph (J)

V P Gangadharan (VP)

Shibi Mathew (S)

Satheesh Iype (S)

Rommel Sandhyav (R)

Pradeep G Mathew (PG)

N P Kamalesh (NP)

Jacob Mathew (J)

Informations de copyright

Références

Sirohi B, Shrikhande SV, Gaikwad V, et al. Indian council of medical research consensus document on hepatocellular carcinoma. Indian J Med Res. 2020;152:468–74.

doi: 10.4103/ijmr.IJMR_404_20 pubmed: 33707388 pmcid: 8157895

Petrick JL, Florio AA, Znaor A, et al. International trends in hepatocellular carcinoma incidence, 1978–2012. Int J Cancer. 2020;147:317–30.

doi: 10.1002/ijc.32723 pubmed: 31597196

Krishan S, Dhiman RK, Kalra N, et al. Joint Consensus Statement of the Indian National Association for Study of the Liver and Indian Radiological and Imaging Association for the Diagnosis and Imaging of Hepatocellular Carcinoma Incorporating Liver Imaging Reporting and Data System. J Clin Exp Hepatol. 2019;9:625–51.

doi: 10.1016/j.jceh.2019.07.005 pubmed: 31695253 pmcid: 6823668

Kumar A, Acharya SK, Singh SP, et al. 2019 Update of Indian National Association for Study of the Liver Consensus on Prevention, Diagnosis, and Management of Hepatocellular Carcinoma in India: The Puri II Recommendations. J Clin Exp Hepatol. 2020;10:43–80.

doi: 10.1016/j.jceh.2019.09.007 pubmed: 32025166

Tohra S, Duseja A, Taneja S, et al. Experience with changing etiology and nontransplant curative treatment modalities for hepatocellular carcinoma in a real-life setting—A retrospective descriptive analysis. J Clin Exp Hepatol. 2021;11:682–90.

doi: 10.1016/j.jceh.2021.02.002 pubmed: 34866847 pmcid: 8617543

David D, Raghavendran A, Goel A, et al. Risk factors for non-alcoholic fatty liver disease are common in patients with non-B non-C hepatocellular carcinoma in India. Indian J Gastroenterol. 2017;36:373–9.

doi: 10.1007/s12664-017-0785-x pubmed: 28975595

Ioannou GN. Epidemiology and risk-stratification of NAFLD-associated HCC. J Hepatol. 2021;75:1476–84.

doi: 10.1016/j.jhep.2021.08.012 pubmed: 34453963

Younossi ZM, Henry L. Epidemiology of non-alcoholic fatty liver disease and hepatocellular carcinoma. JHEP Rep. 2021;3: 100305.

doi: 10.1016/j.jhepr.2021.100305 pubmed: 34189448 pmcid: 8215299

Lange NF, Radu P, Dufour JF. Prevention of NAFLD-associated HCC: role of lifestyle and chemoprevention. J Hepatol. 2021;75:1217–27.

doi: 10.1016/j.jhep.2021.07.025 pubmed: 34339764

Tokushige K, Ikejima K, Ono M, et al. Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis 2020. J Gastroenterol. 2021;56:951–63.

doi: 10.1007/s00535-021-01796-x pubmed: 34533632 pmcid: 8531062

Castellana M, Donghia R, Lampignano L et al. Prevalence of the absence of cirrhosis in subjects with NAFLD-associated hepatocellular carcinoma. J Clin Med. 2021;10:4638.1–4638.13.

Foerster F, Gairing SJ, Müller L, Galle PR. NAFLD-driven HCC: safety and efficacy of current and emerging treatment options. J Hepatol. 2021;76:446–57.

doi: 10.1016/j.jhep.2021.09.007 pubmed: 34555422

Golfieri R, Bargellini I, Spreafico C, Trevisani F. Patients with barcelona clinic liver cancer stages B and C hepatocellular carcinoma: Time for a sub-classification. Liver Cancer. 2019;8:78–91.

doi: 10.1159/000489791 pubmed: 31019899

Kumar R, Saraswat MK, Sharma BC, Sakhuja P, Sarin SK. Characteristics of hepatocellular carcinoma in India: A retrospective analysis of 191 cases. QJM. 2008;101:479–85.

doi: 10.1093/qjmed/hcn033 pubmed: 18440958

Paul SB, Chalamalasetty SB, Vishnubhatla S, et al. Clinical profile, etiology and therapeutic outcome in 324 hepatocellular carcinoma patients at a tertiary care center in India. Oncology. 2009;77:162–71.

doi: 10.1159/000231886 pubmed: 19641335

Pal S, Ramachandran J, Kurien RT, et al. Hepatocellular carcinoma continues to be diagnosed in the advanced stage: Profile of hepatocellular carcinoma in a tertiary care hospital in South India. Trop Doct. 2013;43:25–6.

doi: 10.1177/0049475512473600 pubmed: 23443626

Sood A, Midha V, Goyal O, Goyal P, Sood N, Sharma SK. Profile of hepatocellular carcinoma in a tertiary care hospital in Punjab in northern India. Indian J Gastroenterol. 2014;33:35–40.

doi: 10.1007/s12664-013-0373-7 pubmed: 24222369

Musunuri B, Shetty S, Bhat G, Udupa K, Pai A. Profile of patients with hepatocellular carcinoma: An experience from a tertiary care center in India. Indian J Gastroenterol. 2022;41:127–34.

doi: 10.1007/s12664-021-01209-0 pubmed: 35226292 pmcid: 9108108