Survival from hepatocellular carcinoma at a cancer hospital in Pakistan.

OBJECTIVES: To determine the tumour and general characteristics, especially survival, of patients presenting with hepatocellular carcinoma at our tertiary care cancer hospital. PATIENTS AND METHODS: We retrospectively studied 584 charts of patients consecutively registered between 1995 and 2004 at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, in Lahore, Pakistan. Descriptive statistics were obtained for gender, age, tumour size and morphology, alpha fetoprotein level, means of diagnosis, Child-Pugh status, risk factors, treatment given and follow-up. Survival analysis was conducted using the Kaplan-Meier method. RESULTS: Mean age at presentation was 56 years. Four hundred and forty four (76%) were male. Average tumour diameter evaluable in 412 patients was 8 cm. HCC was unifocal in 194 (33%), multifocal in 303 (52%) and unevaluable in 106. Mean AFP was 4,198 u/ml (range 1 - 278,560). Methods of diagnosis were FNA in 71, biopsy in 26, imaging/AFP > 200 in 70, lipiodol angiogram in 42, combinations of two of these in 365 and biphasic CT scans in 10. Initial Child-Pugh available for 400/584 was A in 216, B in 147 and C in 37. Evidence of prior hepatitis B infection was found in 114, and for hepatitis C in 254. Other than the four patients who had TACE followed by surgical resection, treatment was offered to 79/584 patients: among the 48 who had TACE, 26 experienced cancer progression whereas 11 had stable disease ranging from 6 - 20 months; another 11 were lost to follow-up. Of the 14 patients who underwent local resection, 2 were lost to follow-up, 7 developed recurrences but 5 remained disease free for a mean of 33 months. Following ethanol ablation in 17 patients, disease progressed in 5 but remained stable in 2 for a mean of 13 months; 10 were lost to follow-up. At the time of writing, 56 patients are alive (mean follow-up 20 months), 210 are known to have died (mean follow-up 9 months), and 318 were lost to follow-up within 3 months. Median overall survival was 10.5 months, death being the point of interest for survival analysis. Child-Pugh class stratified analysis (400/584) revealed median survival of 12 months for class A, 7.7 months for class B and 4 months for class C (p < 0.001). CONCLUSIONS: Most patients present with large, multifocal tumours, with poor liver function. Sixty one percent had evidence of prior infection with hepatitis B or C. The advanced stage at presentation, poor background liver function in many and the absence of a national liver transplantation program limit treatment options. Only 14% of patients were considered suitable for definitive treatment. Survival correlated with Child-Pugh status at presentation. Overall prognosis remains bleak. There is an urgent need to educate the public about the risks of hepatitis B and C and health professionals about early diagnosis and treatment, including possible development of a sustainable national liver transplant program.

Epithelial ovarian cancer at a cancer hospital in a developing country.

OBJECTIVES: To analyze records of patients seen with malignant epithelial ovarian cancer at a tertiary care cancer hospital in Pakistan and obtain information on factors as laterality, histology, CA-125 levels, and stage of the disease, determine age at presentation and, assess menopausal status of the patients. Also, to review results obtained in light of data published in indexed journals. PATIENTS AND METHODS: We analyzed 544 cases of malignant ovarian epithelial tumors registered at the Shaukat Khanum Memorial Cancer Hospital and Research Center from December 1994-December 2003. RESULTS: Mean age at presentation: 48.1 years (SD 13, range 4-82 years); commonest histological sub-type: serous cystadenocarcinoma (28.6%); most frequently seen stage: 3 (43.5%), followed by stage 4 (22.4%); post-menopausal: 56.8% of the women; bilateral disease: 41.2% of the women; and Cancer Antigen-125 (CA-125) level: elevated in 70% of the females. CONCLUSIONS: Stage at presentation in majority of the cases was advanced as compared to that seen in the west. With only minor variations, our findings seem consistent with those reported in other local studies. However, it is imperative to conduct an extensive population-based study to understand the impact of, and develop strategies for the management of ovarian cancer in Pakistan.

Characteristics of lung cancer patients--the Shaukat Khanum Memorial experience.

OBJECTIVES: The aims of this descriptive study were to characterize lung cancer patients by age at diagnosis, smoking status, and histology and, also to explore the histologic sub-type according to cigarette smoking, in a tertiary care setting. PATIENTS AND METHODS: A retrospective review of 830 patients for whom smoking status was available in the records was carried out at a comprehensive cancer care facility, the Shaukat Khanum Memorial Cancer Hospital and Research Center, situated in Lahore, Pakistan. RESULTS: The mean age at presentation of the 830 evaluable cases was 59.8 years (standard deviation 11.8, range 18-90). Stratifying by gender, statistically significant differences were found in the average age at diagnosis between males (60.1 years) and females (57.5 years) and, in the distributions of non-smokers, current smokers, and ex-smokers, but none for histology. CONCLUSIONS: Similar to other populations, the age of disease onset amongst females was lower than that seen in males. The proportion of smokers was higher amongst males versus females. The reversal of smoker to non-smoker ratio when stratified by gender, may highlight the importance of exploring alternate pathways implicated in the etiology of lung cancer in our population.