Publication: Survival and prognostic factors among patients with hepatocellular carcinoma in Hospital Pakar Universiti Sains Malaysia
Loading...
Date
2024-12
Authors
Hazali, Hazliana
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Introduction: Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide, with over 800,000 new cases diagnosed annually. Studying survival and prognostic rates is crucial to improving patient outcomes, as early detection and effective treatment strategies remain limited, impacting the global burden of this disease. Objectives: The objectives of this study were to determine the median survival time of patients with HCC, compare median survival times across groups based on sociodemographic factors, clinical characteristics, laboratory findings, and treatment modalities, and identify prognostic factors associated with survival among HCC patients in HPUSM. Methodology: A retrospective record review study was conducted involving of 240 patients diagnosed with HCC in HPUSM, Kelantan. Recruitment phase was from 1st January 2012 to 31st December 2021 based on inclusion and exclusion criteria. An additional follow up period was from 1st January 2022 until 31st December 2023 (24 months). Detailed medical records were reviewed by a researcher and all the important information on the variable of interest and patients’ survival status until 31st December 2023 were collected and recorded into a data collection form. Cox proportional hazard regression and Kaplan Meier estimator were used for the data analysis. Results: The finding of this study showed that a total of 199 (92.1 %) patients died due to HCC and its compilation. The overall median survival time for patients with HCC in this study was 9 months (95% CI: 7.0 – 13.0) and the overall one-year survival rate for patients with HCC was 44.1 % (95% CI: 37.0, 52.0). No significant differences were observed in median survival based on sociodemographic factors. However, clinical characteristics such as dyslipidemia (p=0.027), viral hepatitis (p=0.036), liver cirrhosis (p=0.008), abdominal pain, abdominal distension, loss of appetite, weight loss, hepatomegaly, Child-Pugh class, tumor size, and portal vein thrombosis (all p<0.001), as well as jaundice (p=0.002), were significantly associated with survival. Laboratory markers, including Alpha-fetoprotein, Aspartate transferase, Alkaline phosphatase, bilirubin, and International Normalized ratio (all p<0.001), also showed significant prognostic value. Additionally, treatment modalities significantly influenced survival (p<0.001). After adjusting for other variables, the significant prognostic factors that influenced survival in HCC were gender (Adjusted hazard ratio (AHR): 0.64; 95% CI: 0.44, 0.95), viral hepatitis HCV (AHR: 0.60; 95% CI: 0.39, 0.90), abdominal pain (AHR: 1.53; 95% CI: 1.12, 2.10), loss of appetite (AHR: 1.49; 95% CI: 1.03, 2.16), splenomegaly (AHR: 1.69; 95% CI: 1.11, 2.55), Child Pugh class B (AHR: 1.80; 95% CI: 1.28, 2.52), and Child Pugh class C (AHR: 2.74; 95% CI: 1.78, 4.21), Alpha-fetoprotein (AHR: 1.62; 95% CI: 1.13, 2.31), Aspartate transferase (AHR: 1.55; 95% CI: 1.12, 2.14), Alkaline phosphatase (AHR: 1.56; 95% CI: 1.14, 2.13), single treatment (AHR: 0.24; 95% CI: 0.10, 0.56) dan multiple treatment (AHR: 0.16; 95% CI: 0.07, 0.38). Conclusion: The median survival time and one-year survival rate for HCC falls within the range reported in other Asian countries. While sociodemographic factors had no significant impact, clinical characteristics, elevated biomarkers, and treatment modalities were key prognostic factors. The significant prognostic factors that identified in this study were considerably similar with other studies.
Description
Keywords
Hepatocellular carcinoma , median survival