Assessment of a guideline for management of hepatocellular carcinoma [HCC] in Egyptian patients

ABSTRACT

HCC is the commonest liver malignancy all over the world including in Egypt. Many classification system for management of HCC have been proposed but none of them is implemented worldwide. In this work we propose a guideline for management of HCC which is suitable for the Egyptian patient. The suggested guideline of management includes assessment of four areas The general clinical status of the patient, the liver status, the tumor status and options of therapy which are suitable for Egyptian circumstances. In one center, this design was prospectively applied on 79 patients who presented with HCC. The HCC patients showed that Two [2.86%] had non-cirrhotic liver parenchyma, while all the rest had cirrhosis 7 [10.0%] early stage or Child's A [one early and 6 late Child's A], 28 [40.0%] intermediate stage [Child's B] and 33 [47.14%] terminal end stage [Child's C]. Therapy was applied according to the suggested guideline as follows surgical resection for four patients [5.71%], radio frequency ablation [RFA] for 6 [8.57%], percutaneous ethanol injection [PEI] for 39 [55.71%], selective arterial chemoembolization for 2 [2.86%], chemotherapy for 6 [5.57%] and symptomatic therapy for 13 [18.75%] patients. After two years of follow up Fourty four [62.9%] were still living, 20 [28.6%] died while 6 [8.6%] were missed to follow up. Recurrence of HCC was found in 21 [30.0%] cases. The liver status progressed from Child's A to B in four cases out of 7 [57.1%] and from Child's B to C in 24 cases out of 28 [85.71%] within one year. The prognosis of the disease depended on many factors on top of which was the liver functional reserve. Most Egyptian patients with HCC present in a late stage of cirrhosis thus with a bad prognosis as predicted from their clinical status, the liver condition and the tumor status. The progress of the underlying liver disease is more rapid when HCC appears. PEI is a good option of therapy. The predictive factors of good prognosis and improvement in this study were HBV infection and the Child's class. Although the mortality rate was still high [28.5%], but the cost of therapy was reduced due to application of the suggested guideline system. This guideline is simple, easy to apply, covers most HCC presentations, is flexible and may be changed [updated] according to progress in technology, resources of therapeutics, skills of the operators and the patient's presentation. Thus other Egyptian centers can apply this guideline in management of HCC, reevaluating and updating it