Etiology, clinical profile, and treatment pattern of hepatocellular carcinoma at a tertiary care center in North India: A retrospective observational study

Abstract

ABSTRACT Export Background: The prognosis of patients with hepatocellular carcinoma (HCC) is poor due to its non-specific presentation, underlying liver disease, and advanced stage at presentation. There are limited HCC data from India, and no major studies are available from North India. Objectives: To study the epidemiology, etiological factors, clinical profiles, and treatment patterns of patients with HCC at our center. Materials and Methods: This was a retrospective analysis of prospectively collected data of patients with HCC from January 2016 to December 2020, conducted in the Department of Medical Oncology and Gastroenterology at the Sher-i-Kashmir Institute of Medical Sciences (SKIMS), a tertiary center in North India. Patient data and treatment details were collected and analyzed. Results: We enrolled 127 patients in the study. Males constituted the majority (91; 71.7%), with a mean age of 58 ± 12 years. The majority (100; 78%) of patients had cirrhosis; the common etiological factors included hepatitis B virus infection (30; 23.6%), non-alcoholic steatohepatitis (29; 22.8%), and hepatitis C virus infection (22; 17.3%). Although etiology was unknown in 45 (35.4%) patients, around one-third (36.4%) had diabetes mellitus. Most (91; 71.7%) patients had liver-limited disease and the majority (53; 41.7%) presented with Barcelona Clinic Liver Cancer (BCLC) stage C disease, followed by BCLC A (33; 26%), BCLC B (25; 19.7%), and BCLC D (16; 12.6%). Portal vein thrombosis was noted in 40 (32.3%) patients. Liver-directed therapies, including surgery, ablation, and trans-arterial chemoembolization, were received by 17 (13.4%) patients. The most commonly used systemic treatments were sorafenib (32; 25.2%) and lenvatinib (7; 5.5%), but a substantial number of patients (56/127; 44.1%) either did not adhere to, refused therapy or were given best supportive care. Conclusion: The majority of patients with HCC at our center are males and present at a mean age of 58 years. Hepatitis B virus is the most frequent etiological agent. Patients with HCC present with advanced stage disease and are often not considered suitable for curative intent treatment. Sorafenib is the most commonly administered systemic treatment; however, just under half the patients (44.1%) are either unfit for or refuse treatment.