Comparison of Cancer Care for Hepatocellular Carcinoma at Two Tertiary-Care Referral Centers from High and Low Endemic Regions for Viral Hepatitis

Alsohaibani, Fahad; Porter, Geoffrey A.; Al-Ashgar, Hamad I.; Walsh, Mark; Berry, Robert F.; Molinari, Michele; Peltekian, Kevork M.

doi:10.1007/s12029-010-9200-x

Cited by 5 publications

(3 citation statements)

References 24 publications

(23 reference statements)

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“…The largest Saudi study by Sanai et al conducted on 206 HCC patients in 2010 showed HCV preponderance in Saudi HCC patients ( 44 ). While, two other researches by Alsohaibani et al reaffirmed HCV predominance ( 43 ), the oldest study by Ayoola et al on 108 cases in 2004 ended up with a much higher rate of HBV infection (63.6%), compared to a tiny 8.5% of HCV. This showed a chronological disparity in the etiology of HCC in Saudi Arabia ( 45 ).…”

Section: Resultsmentioning

confidence: 92%

Relative Importance of Hepatitis B and C Viruses in Hepatocellular Carcinoma in EMRO Countries and the Middle East: A Systematic Review

Alavian

Haghbin

2016

Hepat Mon

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ContextHepatocellular carcinoma (HCC) is the second most common cancer-related death worldwide. Although many factors including dietary aflatoxin B1 (AFB1) and alcoholic and non-alcoholic fatty liver diseases can lead to HCC, globally most HCC cases are due to hepatitis B virus (HBV) and hepatitis C virus (HCV). Considering the importance of these viral factors in most HCC cases and relative lack of literature from eastern Mediterranean region office of world health organization (EMRO) countries and the Middle East, we decided to perform this systematic review to find distribution of viral etiology of HCC in these regions.Evidence AcquisitionIn this systemic review, we included all studies from 1 January 1989 to 1 September 2015 with at least 20 samples that measured HBV surface antigen (HBsAg) and antibodies to HCV (anti-HCV). The authors searched MEDLINE, Embase, Popline, Web of Science and WHO indexed databases. We searched the following MeSH terms; hepatocellular carcinoma, hepatitis B virus and hepatitis C virus or hepacvirus. Only studies using second- and third-generation HCV assays were included. Only articles studying HCC patients from EMRO countries and the Middle East were analyzed. Duplicate results that reported the same cases more than once were found and omitted. Studies in English and Farsi were reviewed. If the study was eligible, we recorded the following data; the first author, publication year and journal, study population and number and percentage of patients with different serologic statuses.ResultsWe found 44 studies from 12 countries in EMRO and the Middle East. HCC cases from Iran, Lebanon, Turkey and Yemen were mainly due to HBV, while those of North African nations (Egypt, Tunisia, Morocco, Algeria and Somalia) in addition to Saudi Arabia and Pakistan were mostly HCV related. Sudan showed a high seronegativity and HBV infection in its HCC cases. Unfortunately, some countries from EMRO and the Middle East did not have eligible studies.ConclusionsHBV and HCV are important culprits of HCC in EMRO countries and the Middle East and different nations need different strategies to tackle them accordingly. Countries with high rates of HBV such as Turkey should continue their HBV vaccination and also increase sanitation. Nations with high HCV rates such as Egypt should maintain their blood product monitoring in addition to increased sanitation, especially regarding injection drug users (IDU).

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Section: Resultsmentioning

confidence: 92%

Relative Importance of Hepatitis B and C Viruses in Hepatocellular Carcinoma in EMRO Countries and the Middle East: A Systematic Review

Alavian

Haghbin

2016

Hepat Mon

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“…Many previous reports have confirmed the association between thrombocytopenia and HCC [27]. For example, it has been suggested that thrombocytopenia in a cirrhotic patient is more commonly associated with the development of HCC compared to non-thrombocytopenic, cirrhotic patients [18]- [20] [27]. Furthermore, patients with thrombocytopenia are more likely to have advanced hepatocellular carcinoma [28].…”

Section: Discussionmentioning

confidence: 89%

Causes and Stages of Hepatocellular Carcinoma at Patient Presentation at a Tertiary Medical Center in Western Saudi Arabia

Alkhayyat¹,

Fallatah²,

Akbar³

et al. 2014

JCT

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Background: With 748,300 new cases diagnosed every year, hepatocellular carcinoma (HCC) is the 5 th and the 7 th most common cancer among males and females, respectively, and causes 7% of all cancer-related deaths. HCC represents more than 90% of primary liver cancers. Objective: The aim of the present study was to recognize the stages of HCC at presentation in patients who were diagnosed at King Abdul Aziz University Hospital (KAUH) and to identify the associated laboratory features of advance HCC. Materials and Methods: A retrospective analysis of 57 HCC patients admitted to KAUH between January 2008 and December 2012 was conducted. The diagnosis was established using ultrasound (U/S), computed tomography (CT) and/or magnetic resonance imaging (MRI), with or without a liver biopsy, as well as blood testing for alpha-fetoprotein. The following data were extracted from the medical records at KAUH: patient demographics (age, sex and nationality), laboratory results (CBC, LFT, PT, INR and alpha-fetoprotein), radiological results, biopsy results for those patients who underwent biopsy, outcomes (living, deceased or lost from the follow-up), and mortality and survival rates. Results: A total of 57 HCC patients were admitted during the study period, and 3 patients were excluded from the analysis. Of the remaining 54 patients, 44 (81.5%) were males and 10 (18.5%) were females. The mean age was 64.54 years (SD, 11.2 years; range, 31-86 years). The majority of patients were Saudis (19, 35.2%), non-Saudis (35, 64.8%), Egyptians (9, 16.6%) and Yemenis (7, 13%). The remaining 19 (35.2%) patients comprised other nationalities. Chronic hepatitis C virus was the most common cause for liver cirrhosis (35 patients, 64.8%). CT was the primary diagnostic method (37 patients 68.5%), while 9 (16.7%) cases were confirmed by adnominal MRI. Six patients (11.1%) were diagnosed with abdominal ultrasound * Corresponding author. S. Alkhayyat et al. 1304 examination and elevated alpha-fetoprotein levels. In 2 (3.7%) patients, HCC was confirmed by liver biopsy. The majority of the patients (37, 68.5%) had advanced disease. Only 21 (39%) patients underwent radio frequency appellation (RFA). The mean survival time from diagnosis to death was 5.9 months (SD, 5.7 months), and the longest survival time to death was 20 months. Conclusion: The majority of our patients presented at an advanced disease stage, and CHC was the most common underlying cause for liver cirrhosis in our cohort of HCC patients. The proper implementation of HCC screening programs for cirrhotic patients is expected to help detect the treatable stages of HCC in a timely manner.

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“…The causal distribution of HCC shows geographic variations. Thus, in Canadian patients, 45% of cases were attributable to alcohol-induced cirrhosis, 26% to cryptogenic cirrhosis and 13% to hepatitis C. In patients from Saudi Arabia, 47% of HCC were caused by hepatitis C, 27% by cryptogenic cirrhosis and 21% to hepatitis B [48]. In USA, regarding the HCC cause, 54.9% of cases were induced by HCV, 16.4% by alcohol, 14.1% by NAFLD and 9.5% by HBV [10].…”

Section: Nash-induced Hccmentioning

confidence: 99%

Non-Alcoholic Steatohepatitis, Liver Cirrhosis and Hepatocellular Carcinoma: The Molecular Pathways

Mezale¹,

Štrumfa²,

Vanags³

et al. 2017

Liver Cirrhosis - Update and Current Challenges

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Non-alcoholic steatohepatitis (NASH) is growing into global problem, mainly due to NASH-induced cirrhosis and hepatocellular carcinoma (HCC), that can develop either subsequently to cirrhosis or preceding it. In addition, NASH-induced cirrhosis constitutes a significant fraction of cases diagnosed as cryptogenic cirrhosis. Thus, there is a need for deeper understanding of the molecular basis, leading to liver steatosis, then-to the associated inflammation seen in NASH, loss of liver architecture and cirrhosis, followed or paralleled by carcinogenesis and HCC. Insulin resistance, increased hepatic iron level, and certain cytokines, including TNF-α and IL-6 derived from extrahepatic adipose tissues, can trigger the chain of events. The imbalance between leptin and adiponectin is important as well. These markers remain important during the whole course from NASH through liver cirrhosis to HCC. The molecular pathogenesis substantiates treatment: hypertriglyceridemia can be lowered by low calorie diet; mTOR complex can become inhibited by physical activity and metformin; cholesterol synthesis, RAF/ MAPK1/ERK and p21 pathway by statins; inflammation by pentoxyfillin, and kinases (in HCC) by sorafenib. Bidirectional regulation of telomere attrition, senescence and p21 pathway, restoration of wild-type p53 activity and regulation of miRNA network represent attractive future treatment options. Focusing on relevant molecular pathways allows deeper understanding of NASH pathogenesis, leading to identification of predictive markers and treatment targets.[10] and other Western industrialised countries, facing high occurrence of the major risk factors for NAFLD, namely, central obesity, type 2 diabetes mellitus, dyslipidemia and metabolic syndrome [11]. In a recent meta-analysis of 86 studies, comprising 8,515,431 persons from 22 countries, the global prevalence of NAFLD was 25.24% (95% confidence interval [CI], showing the highest occurrence in the Middle East and South America and the lowest in Africa [5].Liver Cirrhosis -Update and Current Challenges 2 Thus, 90% of patients suffering from morbid obesity (defined as having body mass index 40 kg/m 2 or higher) and 74% patients affected by diabetes mellitus develop NAFLD. In addition, NAFLD has been observed even in non-obese, non-diabetic patients who have increased insulin levels in blood and resistance to insulin action. Consequently, NAFLD affects up to 20-30% of adults in Europe and 46% in the USA: a tremendously high prevalence for a condition that can cause any significant complications [9, 10]. Non-Alcoholic Steatohepatitis, Liver Cirrhosis and Hepatocellular Carcinoma: The Molecular Pathways http://dx.doi.org/10.5772/intechopen.68771 3Most patients are diagnosed with NAFLD in their 40s or 50s. Studies vary in regard to the gender distribution of NAFLD, with some suggesting that it is more common in women and others suggesting more frequent occurrence in men [11,12].Since 1998, non-alcoholic fatty liver disease has been considered a condition with a "two-hit" course of...

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Comparison of Cancer Care for Hepatocellular Carcinoma at Two Tertiary-Care Referral Centers from High and Low Endemic Regions for Viral Hepatitis

Abstract: This study validates divergence in HCC presentation between low and high endemic regions for viral hepatitis. In addition, for the first time, differences in cancer care of HCC are documented.

Cited by 5 publications

References 24 publications

Relative Importance of Hepatitis B and C Viruses in Hepatocellular Carcinoma in EMRO Countries and the Middle East: A Systematic Review

Relative Importance of Hepatitis B and C Viruses in Hepatocellular Carcinoma in EMRO Countries and the Middle East: A Systematic Review

Causes and Stages of Hepatocellular Carcinoma at Patient Presentation at a Tertiary Medical Center in Western Saudi Arabia

Non-Alcoholic Steatohepatitis, Liver Cirrhosis and Hepatocellular Carcinoma: The Molecular Pathways

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