A study of 3013 cases of hepatocellular carcinoma: Etiology and therapy before and during the current decade
Miao-Shan Lim 1 , George B-B Goh 1 , Jason P-E Chang 1 , Jee-Keem Low 2 , Vishalkumar G Shelat 2 , Terence C-W Huey 2 , Yock-Young Dan 3 , Alfred Kow 4 , Iyer Shridhar 4 , Poh-Seng Tan 3 , Sameer P Junnarkar 2 , Chee-Kiat Tan 1
Affiliations
Affiliations
1
Department of Hepatology and Gastroenterology Singapore General Hospital Singapore.
2
Department of General Surgery (Hepato-Pancreato-Biliary Surgery Service) Tan Tock Seng Hospital Singapore.
3
Division of Gastroenterology and Hepatology, University Medicine Cluster National University Health System Singapore.
4
Division of Hepatobiliary and Pancreatic Surgery, University Surgical Cluster National University Health System Singapore.
Background and aim: Hepatocellular carcinoma (HCC) is a significant global problem. With advances in HCC diagnosis and therapy, our hypothesis is that there are significant differences in the clinical characteristics and treatment of HCC over the years.
Methods: Patients with HCC between 1980 and 2018 from three major tertiary hospitals in Singapore were enrolled into a Research Electronic Data Capture database. Clinical characteristics and treatment of HCC were compared between those diagnosed before 2008 (cohort A) and during the current decade (ie from 2008 onwards) (cohort B).
Results: There were 3013 patients. Mean age of HCC diagnosis was significantly older in cohort B (68.6 vs 61.2 years, P < 0.001). The most common etiology remained as chronic hepatitis B infection but the proportion due to hepatitis B was significantly lower in cohort B (46.6% vs 57.2%, P < 0.0001). The prevalence of cryptogenic/non-alcoholic steatohepatitis was significantly higher in cohort B than cohort A (27.1% vs 18.6%, P < 0.0001). More patients received curative therapy in cohort B (43.7% vs 27.1%, P < 0.0001.
Conclusion: In this largest collection of HCC patients in Singapore, patients are diagnosed with HCC at an older age and cryptogenic/non-alcoholic steatohepatitis is becoming more important as an etiology of HCC in the current decade. More patients also received curative therapy in the current decade.
"Over the years, there have been advances in the diagnosis
and treatment of HCC.6 The dynamic imaging modalities of
computerized tomography (CT) and magnetic resonance imaging
(MRI)7 allow definitive diagnosis of early HCC detected during
surveillance with ultrasound,8 hence improving the chances of
curative treatment" 多年来,在诊断方面取得了进展6 HCC 的动态成像方式
计算机断层扫描 (CT) 和磁共振成像(MRI)7 可明确诊断在治疗期间检测到的早期 HCC
用超声波进行监测,8 从而提高了治疗 .
Treatment modalities for HCC were further divided into
curative, palliative, and best supportive care. Curative treatment
modalities include surgical resection, percutaneous ethanol injec-
tion therapy (PEIT), radiofrequency ablation (RFA), and liver
transplantation. Palliative modalities include transhepatic arterial
chemoembolization (TACE), selective internal radiation (SIRT),
sorafenib, or other systemic chemotherapy.
HCC的治疗方式进一步分为
治疗性、姑息性和最佳支持性护理。 治疗方法包括手术切除、经皮乙醇注射
治疗 (PEIT)、射频消融 (RFA) 和肝脏移植。 姑息疗法包括经肝动脉化疗栓塞 (TACE)、选择性内照射 (SIRT)、索拉非尼或其他全身化疗。
意思是 : 在当前[从 2008 年开始 ]的十年中,更多的[HCC患者][与 1980 年至 2008 年的 HCC 患者相比 ]接受了治愈性治疗. [43.7% vs 27.1%, P < 0.0001.]