Evaluation of Clinical and Biochemical Parameters in Hepatocellular Carcinoma: Experience from an Indian Center

Background: Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. Several etiologic factors including hepatitis viruses, alcohol and aflatoxin have been implicated in the pathogenesis of HCC. However, there is limited information regarding clinicopathological profile of HCC from the Indian subcontinent.

Methods: Forty seven patients of HCC (M=43, F=4) diagnosed on the basis of history, clinical examination, imaging (USG, CT/MRI), alpha-fetoprotein (AFP) and by USG/CT guided FNAC, were included. Patients were screened for HBV, HCV and history of alcohol. Tumor size was assessed on imaging and UGI endoscopy for the presence of varices.

Results: The mean age was 53.4+/-14.6 y. Clinical presentation included anorexia in 32 (68%), abdominal pain in 28 (60%), loss of weight in 23 (49%), fever in 12 (26%), and jaundice in 6 (13%) patients. Twenty nine (62%) had underlying cirrhosis, diagnosed by ultrasound or CT. Seventeen percent had normal AFP (<10 ng/ml) and the remaining 83% had raised AFP [<10 ng/ml=7, 10-400 ng/ml=27, >400 ng/ml=8]. Thirteen patients (28%) were consuming alcohol in cirrhogenic doses and 10 (21%) were smokers. Fifty four percent were positive for HBsAg, 47% of these were also positive for HBeAg. Twenty seven percent were positive for anti-HCV. Tumor size on imaging was analyzed in 33 patients. Tumor size varied from <3 cm in 8 (18%), 3-5 cm in 12 (27%) and >5 cm in 25 (56%) patients. Twenty-three patients were lost to follow-up, 4 died and 6 did not agree for any treatment. Only 5 patients could be subjected to hepatic resection. Remaining 9 patients had a large tumor size and were put on tamoxifen.

Conclusion: More than half of the HCC cases have underlying cirrhosis. Hepatitis B virus infection is commonly associated. Most of patients have a large tumor (>5 cm) at presentation.