A profile of primary hepatocellular carcinoma patients in the Gizan Area of Saudi Arabia

Abstract

Clinical, laboratory, and ultrasonographic features of 75 patients of primary hepatocellular carcinoma (PHC) living in the Gizan Area of Saudi Arabia and their follow-up, during a 2-year period, were characterized. Eighty-nine percent of the cases were defined histologically, whereas in the rest, ultrasonographic (US) evidence along with an alphafetoprotein (AFP) level exceeding 480 ng/ml were taken as the positive evidence for PHC. Eighty percent of the cases were male patients, with the peak incidence during the seventh decade. The most common clinical presentations were hepatic enlargement (91%), abdominal pain (76%), splenic enlargement (33%), and acites (33%), followed by bruit, fever, metastases, and varices. Alteration in a liver function test was manifest in 97% of the cases, AFP values greater than 480 ng/ml in 57%, and a hepatitis B virus surface antigen (HBsAg) positivity in 65% of the cases. There was no intersex variation in positivity for HBsAg, antibody to HBsAg (anti-HBs), antibody to hepatitis B virus core antigen (anti-HBc) among the 30 PHC cases studied. Positivity for HBsAg or the overall hepatitis B virus exposure in PHC cases was higher than the normal controls (P less than 0.001). In addition to histologic confirmation of PHC in 67 cases, there was histologic evidence of cirrhosis in 25%, or chronic active hepatitis in 19% of the cases. At the time of diagnosis, the average duration of the presenting illness was less than 2 months, while the mortality in the ensuing 2-month period was 73%. The average span of total illness in the vast majority of cases was 4 to 6 months. Two female patients (one with fibrolamellar carcinoma) however, survived for 2 years. Immunization against hepatitis B virus should be considered for all newborns in such hyperendemic communities. A continuous program should be started in such communities to screen and immunize all those yet unexposed to hepatitis B virus. The established HBsAg carriers should be periodically examined ultrasonographically along with an AFP estimation for initiating the chemotherapeutic and other measures against PHC in fairly early stages of malignancy.

Cancer in the Gizan Province of Saudi Arabia: An Eleven Year Study

“…Schistosomiasis is more common in Gizan than in other parts of Saudi Arabia, 26 and the possibility of a role in the pathogenesis of HCC has not been elucidated. [26][27][28] In our study, lymphoma/leukemia (LL) was the third most common malignancy with a CRF of 13.5% overall. This high incidence is in keeping with other reports from Saudi Arabia.…”

Hepatocellular Carcinoma in Saudi Arabia: Evaluation of Prognostic Factors

“…13,15,16 Furthermore, systemic chemotherapy has yielded little progress in the management of the disease. 17,18 The few reports on HCC in Saudi Arabia 18,19 superficially analyzed the prognostic factors influencing survival. This has prompted us to elucidate the effect of several variables on survival in Saudi patients with HCC.…”

Prevalence of Antibodies to Hepatitis C Virus in Saudi Patients with Chronic Liver Disease

“…The prevalence of HBsAg in cirrhosis (CH) and hepatocellular carcinoma (HCC) is high [3,4]. The assessment of the contribution of non-A, non-B hepatitis viruses [NANB] to the etiology ofacute and chronic liver disease and HCC has been hampered by lack of specific markers for these agents.…”

“…1991; 11(5): 497-500 Chronic hepatitis B virus infection and schistosomiasis are the leading etiological agents of chronic liver disease (CLD) in the Kingdom of Saudi Arabia [1,2, Fakunle et al (in press)]. The prevalence of HBsAg in cirrhosis (CH) and hepatocellular carcinoma (HCC) is high [3,4]. The assessment of the contribution of non-A, non-B hepatitis viruses [NANB] to the etiology ofacute and chronic liver disease and HCC has been hampered by lack of specific markers for these agents.…”