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      Clinical characteristics analysis of 1180 patients with hepatocellular carcinoma secondary to hepatitis B, hepatitis C and alcoholic liver disease

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          Abstract

          Objective

          To determine the clinical and liver stiffness characteristics of a cohort of Chinese patients with Hepatocellular carcinoma in different stages of Barcelona clinic liver cancer.

          Methods

          Details of 1180 patients with Hepatocellular carcinoma referred from October 2014 to November 2017 were collected retrospectively. Demographic data, etiology, clinical, and biochemical details were retrospectively analyzed. The changes of liver stiffness in different etiologies and different stages of Barcelona clinic liver cancer were especially analyzed.

          Results

          The onset age was 60.33 ± 9.11 (range 24‐84) years, 9 cases were ≤40 years, 572 cases were 41‐60 years, males accounted for 83.92%, females accounted for 16.08%; 599 cases were ≥61 years, males accounted for 78.25%, females accounted for 21.75%. Compared with males, the proportion of females ≥61 is higher than that of men. Majority (n = 787; 66.69%) had HBV infection; second commonest cause was HCV infection (n = 217; 18.39%). More patients with HBV infection were 41‐60 years (69.06%) and were younger than HCV patients. There was no statistical difference in etiology, age, gender, and distribution of diabetes mellitus among different Barcelona clinic liver cancer stages ( P > .05). The overall Hepatocellular carcinoma (HCC) was found to be positively correlated with alkaline phosphatase, γ‐glutamyltransferase, and alpha‐fetoprotein and liver stiffness measurement values from stage A to stage D ( P < .05). ANOVA analysis showed that the overall liver stiffness measurement among the four BCLC stages was found to be statistically significant different in HBV‐infected and HCV‐infected HCC patients.

          Conclusion

          Majority (99.24%) were patients aged >40 years old. Male is a high incidence population. In etiological analysis, HBV dominates HCC occurrence, HBV‐, HCV‐, and alcohol‐associated HCC have distinct clinical and biochemical characteristics, necessitating different screening policies to optimize HCC surveillance and management.

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          Most cited references29

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          Rising incidence of hepatocellular carcinoma in the United States.

          H B El-Serag, A Mason (1999)
          Clinical observations have suggested that the number of cases of hepatocellular carcinoma has increased in the United States. We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) data base to determine the age-adjusted incidence of hepatocellular carcinoma from 1976 to 1995, data from the U.S. vital-statistics data base to determine age-adjusted mortality rates from 1981 to 1995, and data from the Department of Veterans Affairs to determine age-adjusted rates of hospitalization for the disease from 1983 to 1997. The incidence of histologically proved hepatocellular carcinoma increased from 1.4 per 100,000 population (95 percent confidence interval, 1.3 to 1.4) for the period from 1976 to 1980 to 2.4 per 100,000 (95 percent confidence interval, 2.3 to 2.4) for the period from 1991 to 1995. Among black men, the incidence was 6.1 per 100,000 for the period from 1991 to 1995, and among white men, it was 2.8 per 100,000. There was a 41 percent increase in the mortality rate from primary liver cancer and a 46 percent increase in the proportion of hospitalizations attributable to this disease during the periods studied. The incidence increased significantly among younger persons (40 to 60 years old) during the period from 1991 to 1995 as compared with earlier periods. An increase in the number of cases of hepatocellular carcinoma has occurred in the United States over the past two decades. The age-specific incidence of this cancer has progressively shifted toward younger people.
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            The diagnosis and treatment of hepatocellular carcinoma.

            Justin Hartke, Matthew W. Johnson, Marwan Ghabril (2017)
            Hepatocellular carcinoma is a leading cancer worldwide. Its incidence is increasing, and is closely related to advanced liver disease. Cirrhosis represents the greatest risk factor for this malignancy, and is the main indication for screening and surveillance. The diagnosis of hepatocellular carcinoma can frequently, and uniquely, be made on characteristic multiphase contrast based cross-sectional imaging rather than strict need for tissue sampling. Despite advances in medical, locoregional and surgical therapies, hepatocellular carcinoma remains one of the most common causes of cancer-related death globally. In this review, current approaches to management of hepatocellular carcinoma are discussed, which incorporate both tumor and patient factors. The salient considerations in surgical (resection, liver transplantation), locoregional (ablation and embolic therapies) and medical therapies are highlighted.
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              Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups.

              T Poynard, P Bedossa, P Opolon (1997)
              Our aim was to assess the natural history of liver fibrosis progression in hepatitis C and the factors associated with this progression. We recruited 2235 patients from the Observatoire de l'Hépatite C (OBSVIRC) population, the Cohorte Hépatite C Pitié-Salpétrière (DOSVIRC) population, and the original METAVIR population. All the patients had a biopsy sample compatible with chronic hepatitis C as assessed by the METAVIR scoring system (grades the stage of fibrosis on a five-point scale, F0 = no fibrosis, F4 = cirrhosis, and histological activity on a four-point scale, A0 = no activity, A3 = severe activity). No patient had received interferon treatment before the liver biopsy sample was obtained. We assessed the effect of nine factors on fibrosis progression: age at biopsy; estimated duration of infection; sex; age at infection; alcohol consumption; hepatitis C virus C (HCV) genotype; HCV viraemia; cause of infection; and histological activity grade. We defined fibrosis progression per year as the ratio between fibrosis stage in METAVIR units and the duration of infection (1 unit = one stage, 4 units = cirrhosis). The median rate of fibrosis progression per year was 0.133 fibrosis unit (95% CI 0.125-0.143), which was similar to the estimates from previous studies (0.146 to 0.154). Three independent factors were associated with an increased rate of fibrosis progression: age at infection older than 40 years, daily alcohol consumption of 50 g or more, and male sex. There was no association between fibrosis progression and HCV genotype. The median estimated duration of infection for progression to cirrhosis was 30 years (28-32), ranging from 13 years in men infected after the age of 40 to 42 years in women who did not drink alcohol and were infected before the age of 40. Without treatment, 377 (33%) patients had an expected median time to cirrhosis of less than 20 years, and 356 (31%) will never progress to cirrhosis or will not progress for at least 50 years. The host factors of ageing, alcohol consumption, and male sex have a stronger association with fibrosis progression than virological factors in HCV infection.
              Article 0 comments Cited 203 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Tao Han: hantaomd@126.com
                Journal
                Journal ID (nlm-ta): J Clin Lab Anal
                Journal ID (iso-abbrev): J. Clin. Lab. Anal
                Journal ID (doi): 10.1002/(ISSN)1098-2825
                Journal ID (publisher-id): JCLA
                Title: Journal of Clinical Laboratory Analysis
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0887-8013
                ISSN (Electronic): 1098-2825
                Publication date (Electronic): 28 October 2019
                Publication date Collection: February 2020
                Volume: 34
                Issue: 2 ( doiID: 10.1002/jcla.v34.2 )
                Electronic Location Identifier: e23075
                Affiliations
                [ 1 ] The Third Central Clinical College of Tianjin Medical University Tianjin China
                [ 2 ] Department of Gastroenterology The First Hospital of Shanxi Medical University Taiyuan China
                [ 3 ] Department of Hepatology and Gastroenterology The Third Central Hospital of Tianjin Tianjin Key Laboratory of Artificial Cell Tianjin Institute of Hepatobiliary Disease Artificial Cell Engineering Technology Research Center of Public Health Ministry Tianjin Third Central Hospital Affiliated to Nankai University Tianjin China
                [ 4 ] Department of Pathology The First Hospital of Shanxi Medical University Taiyuan China
                [ 5 ] Suzhou Erye Pharmaceutical Corporation Suzhou China
                [ 6 ] Department of Hepatology Taiyuan City Third People's Hospital Taiyuan China
                Author notes
                [*] [* ] Correspondence

                Tao Han, Department of Hepatology and Gastroenterology, The Third Central Hospital of Tianjin, The Third Central Clinical College of Tianjin Medical University, 83 Jintang Road, Hedong District, Tianjin 300170, China.

                Email: hantaomd@ 123456126.com

                Author information
                https://orcid.org/0000-0002-9177-5519
                Article
                Publisher ID: JCLA23075
                DOI: 10.1002/jcla.23075
                PMC ID: 7031605
                PubMed ID: 31659795
                SO-VID: 51c5e759-7a7c-4caa-9a1f-9efc56fcdba7
                Copyright © © 2019 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals, Inc.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date received : 04 April 2019
                Date revision received : 12 July 2019
                Date accepted : 29 September 2019
                Page count
                Figures: 2, Tables: 6, Pages: 8, Words: 6069
                Funding
                Funded by: the National Natural Science Foundation of China , open-funder-registry 10.13039/501100001809;
                Award ID: 81870429
                Funded by: the 2017 National 13th 5‐Year Plan for Hepatitis Research
                Award ID: 2017ZX10203201‐007
                Categories
                Subject: Research Article
                Subject: Research Articles
                Custom metadata
                source-schema-version-number 2.0
                cover-date February 2020
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.5 mode:remove_FC converted:20.02.2020

                ScienceOpen disciplines: Clinical chemistry
                Keywords: alcoholic liver disease,alpha‐fetoprotein,hepatocellular carcinoma,liver stiffness measurement,viral hepatitis
                Data availability:
                ScienceOpen disciplines: Clinical chemistry
                Keywords: alcoholic liver disease, alpha‐fetoprotein, hepatocellular carcinoma, liver stiffness measurement, viral hepatitis

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