Evaluation of Clinical, Biochemical, Virological and Etiological Parameters in Patients of Hepatocellular Carcinoma: Experience from a Tertiary Care Center

Aims and Objective: There is dearth of data on clinical, biochemical, virological and etiological parameters in hepatocellular carcinoma (HCC) patients from India. HCC is the most common primary liver malignancy. We enrolled HCC patients to study their clinical, biochemical, virological and etiological parameters and to see the association of viral load and tumor character. Material and Methods: This was a prospective study from June 2005 to May 2007 enrolling newly diagnosed patients of HCC. The diagnosis was based on fulfilment of two of the three criteria (a) Alpha-fetoprotein(AFP) > 300 ng/ml, (b) Dual phase contrast enhanced computed tomography (CECT) of abdomen or magnetic resonance imaging (MRI) evidence of arterialization on arterial phase and wash-out on portal phase, and (c) fine needle aspiration cytology (FNAC) suggestive of hepatocellular carcinoma. The patients’ demographic, clinical profile and characteristics of HCC were studied. Laboratory investigation included hemogram, liver function test, renal function test, coagulogram parameters, ultrasound abdomen, dual phase CECT or MRI abdomen, esophagogastroduodenoscopy, viral markers (HbsAg, HbeAg, anti-HBe, anti-HBc total, HBV DNA, anti-HCV, HCV RNA, ANA, SMA, AMA, S. Iron, S. Ferritin, TIBC, S.ceruloplasmin), AFP and FNAC from liver SOL were done for the etiology of chronic liver disease. Results: Fifty-eight patients of HCC (male: female 49:9) were diagnosed. The mean age was 54.9 (range 21–76 years). The clinical presentation included anorexia in 36 (63%), abdominal pain and distension in 31 (53.4%), jaundice in 10 (20%), fever, mass in epigastrium in 4 (7%) and melena in 2 (3.4%). Forty-nine (84.5%) of them had underlying cirrhosis, diagnosed by ultrasound or computed tomography. Thirty-two (55.2%) patients had raised AFP. The etiology was hepatitis B in 33 (56.8%), hepatitis C in 3(5.1%), alcohol in 6(10.4%) and alcohol and hepatitis B in 2 (3.4%), respectively. Forty-nine (84.5%) had tumor size larger than 5 cm on imaging, the commonest was right lobe involvement in 36 (62%) patients. Portal vein involvement occurred in 28 (49%), inferior vena cava in 5 (8.7%), splenic vein in 4 (7%), and superior mesenteric vein in 1 (1.7%), respectively. FNAC was done in 33 (57%) patients. Sixteen patients had metastases to regional lymph nodes, adrenal and lung. Thirty-two patients died at a mean duration of 4 months (range 1–8 months). None had resectable tumors. HBV-DNA done in 12 patients were more than 4.3 × 10 9 copies/ml and all had tumor size > 5 cm and were unresectable. Conclusion: HCC presented in advanced stage with cirrhosis and venous thrombosis in the majority of patients. Hepatitis B is the etiology in 56.8% of patients. Most of the patients (84.5%) had a large tumor (> 5 cm) at presentation.