ABSTRACT
OBJECTIVE: To identify prognostic determinants of survival in patients with non-resectable hepatocellular carcinoma (HCC), determine the effect of transarterial chemoembolization (TACE) on prognosis, compare hepatitis C related HCC with mixed etiologies and evaluate the prognostic value of different staging systems. METHODS: This cohort study included 129 patients (male = 97, 75%) with non-resectable HCC. Data was collected from 2002 until August 2006. A series of demographic, clinical and biochemical and radiological data were collected. Cases were staged according to the Child's, Okuda, Cancer Liver Italian program (CLIP), Barcelona Clinic Liver Cancer (BCLC) and Chinese University Prognostic Index (CUPI) systems. Survival analysis was performed. Any effect of TACE on prognosis was recorded. RESULTS: Median age of patients was 52 years (range 18-82). Median follow-up 11 months (range 2-36). At the time of analysis, 102 patients had died (79%). Etiology of HCC was hepatitis C virus (HCV) in 66 (51.2%), hepatitis B virus (HBV) 31 (24%), HBV + HCV 10 (7.8%), HBV + delta hepatitis 02 (1.6), and non-B non-C 20 (15.4%). Forty-one patients (31%) were offered TACE. Univariate analysis for HCV related HCC showed that age > 52 years (p<0.05), bilirubin >1.17 mg/dl (p<0.01), INR > 1.3 (p<0.01), alpha fetoprotein > 400 ng/ml (p<0.05), splenomegaly (p<0.01), ascites (p<0.001), portal vein thrombosis (p<0.01), splenic varices (p<0.01), and TACE not offered (p<0.01) were the prognostic factors while in miscellaneous etiology female sex (p<0.05), haemoglobin < 11.0 gm/dl (p<0.01), alkaline Phosphatase > 169 lU/L (p<0.05), ascites (p<0.05) and multifocality (p<0.05) were adversely effecting prognosis. Overall independent determinants were Hepatitis C etiology, female sex and multifocality of tumour (Hazard ratios 3.0, 3.0 and 1.9 respectively). Mean survival was 17.2 vs. 12.8 months for patients offered vs. not offered TACE respectively (p value = 0.015). Okuda, CLIP, BCLC, CUPI and Child's staging systems retained their performance as judged by chi square values in regression analysis. Discriminatory ability for death evaluated by receiver operating characteristic curve was better for Okuda system in the first year. CONCLUSION: Hepatitis C as the etiology of HCC, female sex and multi-focality are associated with poor prognosis. HCV related HCC may differ in prognostic factors from non-HCV HCC. Simple staging system by Okuda predicts prognosis effectively in non-resectable.
Subject(s)
Carcinoma, Hepatocellular/etiology , Hepatitis C/complications , Liver Cirrhosis/complications , Liver Neoplasms/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Hepatocellular/virology , Chi-Square Distribution , Female , Follow-Up Studies , Hepatitis C/epidemiology , Humans , Liver Cirrhosis/epidemiology , Liver Neoplasms/epidemiology , Liver Neoplasms/virology , Male , Middle Aged , Prognosis , Proportional Hazards Models , Prospective Studies , Regression Analysis , Survival AnalysisSubject(s)
Antiviral Agents/therapeutic use , Hepatitis C, Chronic/drug therapy , Interferon-alpha/administration & dosage , Ribavirin/administration & dosage , Adolescent , Antiviral Agents/adverse effects , Child , Child, Preschool , Drug Therapy, Combination , Humans , Infant , Infant, Newborn , Interferon-alpha/adverse effects , Ribavirin/adverse effectsSubject(s)
Antiviral Agents/therapeutic use , Hepatitis B, Chronic/diagnosis , Hepatitis B, Chronic/drug therapy , Adenine/analogs & derivatives , Adenine/therapeutic use , Antiviral Agents/administration & dosage , Child , Child, Preschool , Female , Hepatitis B Surface Antigens/blood , Hepatitis B e Antigens/blood , Hepatitis B, Chronic/epidemiology , Humans , Interferons/therapeutic use , Lamivudine/therapeutic use , Male , Organophosphonates/therapeutic use , Pakistan/epidemiology , Practice Guidelines as TopicSubject(s)
Hepatitis B/complications , Liver Cirrhosis/complications , Pancytopenia/etiology , Splenomegaly/etiology , Adolescent , Child , DNA, Viral/analysis , Diagnosis, Differential , Female , Hepatitis B/diagnosis , Hepatitis B/virology , Hepatitis B e Antigens/immunology , Hepatitis B virus/genetics , Hepatitis B virus/immunology , Humans , Liver Cirrhosis/diagnosis , Liver Cirrhosis/virology , Male , Pancytopenia/diagnosis , Splenomegaly/diagnosisABSTRACT
Progressive familial intrahepatic cholestasis (PFIC) is an important cause of cholestatic liver disease and biliary cirrhosis in pediatric population. Three cases of PFIC are described that were diagnosed on the basis of family history, pruritus, cirrhosis and / or paucity of interlobular bile ducts on liver biopsy and presence of extrahepatic biliary tree on imaging. These patients were initially labeled as suffering from extra-hepatic biliary atresia and neonatal hepatitis. PFIC-1 and 2 could not be differentiated on histological grounds, since these patients presented late and process of fibrosis was advanced.
Subject(s)
Cholestasis, Intrahepatic/diagnosis , Biliary Atresia/diagnosis , Child , Child, Preschool , Cholestasis, Intrahepatic/complications , Cholestasis, Intrahepatic/epidemiology , Disease Progression , Hepatitis/diagnosis , Humans , Liver Cirrhosis/epidemiology , Male , Pruritus/etiologyABSTRACT
Biliary Atresia (BA) is a well-known entity and can present with multiple congenital anomalies. BA is one of the most common conditions in which pediatric liver transplant is performed. Identification of Biliary atresia with situs inversus (SI) has not been documented in Pakistan. We report two such cases. First was an eighty-day-old baby boy, icteric from day of birth. On further evaluation had dextrocardia, SI, gross hydronephrosis (HN) of left kidney and stasis at pelvi ureteric junction (PUJ). Liver biopsy showed biliary cirrhosis secondary to extra hepatic biliary atresia (EHBA). The second baby presented at two months of age. Ultrasound abdomen and hepatobiliary scintigraphy confirmed liver in left hypochondrium (SI) and findings suggestive of BA. Echocardiography confirmed SI with mesocardia. In this paper we have described the association of BA with SI in two patients presenting at the pediatric Gastroenterology, hepatology and nutrition unit.
