Clinical characteristics of hepatocellular carcinoma: Results from central Anatolian region of Turkey

INTRODUCTION: Hepatocellular carcinoma (HCC) is one of the common and highly lethal liver disease in the World. This is a retrospective study that aimed to investigate the risk factors and clinical characteristics of patients with HCC in the Central Anatolian Region of Turkey. METHODS: In this study, 76 patients with HCC from two tertiary care central anatolian hospital were assessed retrospectively during five years period between 2009 -2015 years. Patients were evalueated according to underlying liver disase, time of HCC diagnosis, severity of cirrhosis at presentation, stage of tumor, dynamic radiological imaging features, serum alpha fetoprotein (AFP) levels and treatment method.  RESULTS: The mean age of the patients was 62.8 years and male to female ratio 3.2:1. Etiologically 51.8% of the patients had HBV infection, 28.9% had HCV infection, 3.9% had HCV+HBV infection, 13.1% were idiopathic, one patient was HBV+HDV coinfection and one patient had steatohepatitis. Fifty five percent of the patients had Child-Pugh A when they were diagnosed with HCC. According to the Barcelona Clinical Liver Cancer Staging System 25 patients were stage A and 32 patients were stage B. Cross sectional imaging studies showed that solitary and paucifocal appearance were the dominant tumor patterns, and mass forms were solitary in 50%, paucifocal in 27.7%, multifocal in 19.7% and diffuse in 2.6%. Most of the patient’s (n=43) AFP level was 400ng/ml. Patients with AFP level >400ng/ml were on mild and advanced stage. At the time of HCC diagnosis, 15.7% of the cases had portal vein thrombosis and 9.2% extrahepatic metastasis. 19.7% of the patients were treated with RF and in 14.4% of the patients, tumor resected surgically. TACE was used only in 2.6% of the patients. In 36.8% of the patients there were indication for liver transplantation according to Milan Criteria, but none of the them had liver transplantation. CONCLUSION: Viral hepatitis B and C were the most frequent etiology of HCC in central Anatolian as in Turkey. AFP levels lonely does not seem to be an enough surveillance tool in HCC screening and have to be used with other imaging methods in survey of the patients. Because of the paucity of the donor pool, unfortunately most of the patients could not be treated with liver transplantation.