Hepatocellular Carcinoma: retrospective cohort study of clinical characteristics, treatment and outcome

Aim: The aims of this cohort study are, first, to describe the clinical and etiological profile and, second, to report treatment outcomes of patients with hepatocellular carcinoma presenting to a tertiary care hospital in the North of Portugal. Methods: Retrospective analysis of the electronic charts of 139 patients admitted in our institution between July 2008 and September 2012. Results: The final cohort sample included 116 cases. Alcoholic liver disease was identified in 77%, hepatits C infection was seen in 38% and hepatitis B infection in 18% of patients. Cirrhosis was present in 94% of patients. According to Barcelona Clinic Liver Cancer classification, cancer stage at diagnosis was found as follows: 2% very early, 34% early, 40% intermediate, 7.4% advanced and 15.6% at terminal stage. Treatment allocation was decided in a multidisciplinary team and intention-to-cure treatments included 4 hepatic resections, 22 liver transplantations and 18 ablations. Chemoembolization was primarily allocated as palliative treatment in 46 patients and 6 patients were treated exclusively with sorafenib. Fourteen patients received supportive care only. The Kaplan-Meier estimate for median survival for the entire cohort was 36 months. Treatment was associated with prolonged survival and the best outcomes were seen in transplant patients (median not reached, 1 and 3-year survival rate of 85%). Median survival estimates and survival rates at 1and 3-year for radiofrequency ablation patients and chemoembolized patients were 13 months, 62% and 15% and 26 months, 75%, and 43%, respectively. Conclusion: Chronic harmful alcohol consumption was found to be uncommonly high in this cohort. The majority of patients were diagnosed at late stages of disease which carries a poor prognosis. Comparing with currently available literature, patients undergoing chemoembolization presented with higher long-term survival rates whereas, surprisingly, ablation patients had poorer outcomes. Further studies are recommended to identify additional prognostic factors. Key-words: hepatocellular, Barcelona Clinic Liver Cancer staging, alcoholic liver disease, hepatitis C, hepatitis B, liver transplantation, radiofrequency ablation, chemoembolization, northern Portugal.