Abstract

INTRODUCTION: The primary aim of this retrospective study was to investigate the etiological distribution of hepatocellular carcinoma (HCC) patients who admitted Ege University Medical School Division of Gastroenterology between2005-2017 and the changes of this distribution among 5 years periods. Secondary aim was to investigate the changes of patients’ characteristics during years when they admitted first time 

METHODS: Patients folders were evaluated retrospectively. HCC diagnosed according to MRI, CT, Doppler findings and rarely histopathologically. The recorded parameters were patients’ demographical and clinical characteristics, tumor characteristics, laboratuary findings, treatment modalities and prognostic scores. Etiological assessment was based on laboratuary tests like viral serology, autoantibodies, ceruloplasmin and alpha-1 antitrypsin levels, transferrin saturation, ferritin levels, risk factors for fatty liver and abdominal USG.

RESULTS: There were 474 patients who had HCC final diagnosis and enough data from 2005 to 2017. Five major etiology were Hepatitis B (n= 256; 63.8%), Hepatitis C (n= 83; 20.7%), alcohol (n=27; 6.7%), Hepatitis D (n=16; 4%) and non-alcoholic steatohepatitis (NASH) (n=19; 4.7%). The number of patients who had these 5 etiologies was 401. The mean age was 62.5 ± 9.9. There were 314 (78.3%) male, 87 (21.7%) female patients. There were newly diagnosed 124 patients between 2005-2009, 199 patients between 2010-2014, 99 patients between 2015-2017. Eighty three percent patients had cirrhosis previously. The etiology of HCC was not investigated adequately (n=48) or diagnosis was cryptogenic cirrhosis in 73 patients. There was more than one etiology in few patients. 219 (85.5%) of patients related to Hepatitis B, 44 (53%) of patients related to Hepatitis C, all patients related to alcohol, 11 (69%) of patients related to Hepatitis D, 13 (68%) of patients related to NASH were men (p<0,0001). The mean age of these groups were 61±10, 67±9, 63±9, 56±11, 68±12 respectively (p<0,0001). The distribution of these etiologies between periods of 2005-2009, 2010-2014, 2015-2017 was shown in Figure 1. (Chi square 16.5; p=0.036) (Linear by linear association p=0.019). Consistently changed basal parameters of HCC which were statistically significant were mean of age ( 60.5 ±10.5 [2005-2009]; 63.3 ±9.8 [2010-2014]; 63.7±9.1 [2015-2017] p=0.029) and, male gender 73.4% [2005-2009]; 77.4 [2010-2014]; 88.5% [2015-2017] p= 0.027).

CONCLUSION: HBV and HCV were less; alcohol, NASH and HDV were more effective as etiology of HCC