Estudio descriptivo de la experiencia sobre carcinoma hepatocelular en hígado no cirrótico / Descriptive study of hepatocellular carcinoma in noncirrhotic liver

Introducción y objetivoEl carcinoma hepatocelular (CHC) es la sexta causa de cáncer. En el mundo occidental su incidencia está en aumento y la gran mayoría asientan sobre una cirrosis hepática. El objetivo del estudio fue evaluar las características del CHC en pacientes sin cirrosis.MétodosSe realizó una revisión retrospectiva de 469 pacientes con diagnóstico de CHC durante el periodo de enero de 2003 a diciembre de 2007. Se seleccionaron aquellos pacientes que cumplían criterios histológicos, o la conjunción de criterios clínicos, analíticos, radiológicos y/o de hemodinámica hepática, de ausencia de cirrosis hepática.ResultadosSe identificaron 29 pacientes con diagnóstico de CHC sobre hígado no cirrótico (6,2%). El 86,2% eran varones y con una mediana de edad de 61,6 (23 - 82) años. La enfermedad hepática fue hepatopatía crónica con fibrosis leve-moderada en el 68,9%. El 62,1% de los pacientes se encontraban asintomáticos al diagnóstico. El CHC era un nódulo único en el 86,2%, y la mediana del nódulo mayor fue 46 (20 - 150) mm. Se evidenció invasión vascular macroscópica en dos pacientes y metástasis óseas en otros dos. Se realizó tratamiento activo en 25 pacientes: 15 resección quirúrgica, 6 radiofrecuencia y 4 quimioembolización transarterial. La supervivencia acumulada a 1, 2 y 3 años, fue del 84,3; 67,2 y 50,1%, respectivamente.ConclusionesEl CHC sobre hígado no cirrótico es una patología poco frecuente, siendo tumores de gran tamaño al diagnóstico. A pesar de ello, se pueden aplicar tratamientos con intención curativa y alcanzar una supervivencia superior a la esperable en pacientes con cirrosis(AU)

Introduction and objectiveHepatocellular carcinoma (HCC) is the sixth leading cause of cancer. In western countries its impact is steadily growing and most of these tumors arise in cirrhotic liver. The aim of this study was to evaluate the incidence and characteristics of HCC developing in noncirrhotic patients. Methods: We conducted a retrospective review of 469 patients diagnosed with HCC between January 2003 and December 2007. Patients who met the histological criteria, or a combination of clinical, laboratory, imaging and hemodynamic criteria for the absence of cirrhosis were included.ResultsWe identified 29 patients with a diagnosis of HCC in non-cirrhotic liver (6.2%). Most (86.2%) were men and the median age was 61.6 (23 - 82) years. The most frequent histology of the liver was mild-moderate liver fibrosis (68.9%) and 62.1% of the patients were asymptomatic at diagnosis. HCC was a solitary nodule in 86.2%, and the median size of the main nodule was 46 (20 - 150) mm. Macroscopic vascular invasion was demonstrated in two patients and bone metastases in a further two patients. Active treatment was provided in 25 patients, consisting of tumoral resection in 15, radiofrequency ablation in six and transarterial chemoembolization in four. The overall cumulative survival at 1, 2 and 3years was 84.3%, 67.2% and 50.1%, respectively.ConclusionHCC arising in non-cirrhotic liver is uncommon and there is wide tumor extension at diagnosis. Nevertheless, in most patients, treatment with curative intent can be applied, achieving better survival than that expected patients with cirrhosis(AU)

[Descriptive study of hepatocellular carcinoma in noncirrhotic liver]. / Estudio descriptivo de la experiencia sobre carcinoma hepatocelular en hígado no cirrótico.

INTRODUCTION AND OBJECTIVE: Hepatocellular carcinoma (HCC) is the sixth leading cause of cancer. In western countries its impact is steadily growing and most of these tumors arise in cirrhotic liver. The aim of this study was to evaluate the incidence and characteristics of HCC developing in noncirrhotic patients. METHODS: We conducted a retrospective review of 469 patients diagnosed with HCC between January 2003 and December 2007. Patients who met the histological criteria, or a combination of clinical, laboratory, imaging and hemodynamic criteria for the absence of cirrhosis were included. RESULTS: We identified 29 patients with a diagnosis of HCC in non-cirrhotic liver (6.2%). Most (86.2%) were men and the median age was 61.6 (23 - 82) years. The most frequent histology of the liver was mild-moderate liver fibrosis (68.9%) and 62.1% of the patients were asymptomatic at diagnosis. HCC was a solitary nodule in 86.2%, and the median size of the main nodule was 46 (20 - 150) mm. Macroscopic vascular invasion was demonstrated in two patients and bone metastases in a further two patients. Active treatment was provided in 25 patients, consisting of tumoral resection in 15, radiofrequency ablation in six and transarterial chemoembolization in four. The overall cumulative survival at 1, 2 and 3 years was 84.3%, 67.2% and 50.1%, respectively. CONCLUSION: HCC arising in non-cirrhotic liver is uncommon and there is wide tumor extension at diagnosis. Nevertheless, in most patients, treatment with curative intent can be applied, achieving better survival than that expected patients with cirrhosis.

[Prognostic factors in patients with non-active treatment of hepatocellular carcinoma]. / Factores pronósticos en pacientes con carcinoma hepatocelular desestimado para tratamiento.

OBJECTIVE: To evaluate factors associated with poor survival in patients with non-active treatment of hepatocellular carcinoma (HCC). MATERIAL AND METHODS: Between May 2003 and June 2005, 50 patients with HCC were deemed unsuitable for active treatment, following the Barcelona Clinic Liver Cancer staging system. Symptomatic treatment was provided. Kaplan-Meier curves were constructed and compared by the log-rank test to identify factors associated with poor survival. Independent factors predictive of survival were evaluated by multivariate Cox regression analysis. RESULTS: The mean age was 65.6 +/- 11.9 years and 84% of the patients were men. Forty-eight percent of the patients had hepatitis C infection and 58% were Child-Pugh grade A. HCC was multinodular in 54% and the total tumor size was more than 5 cm in 90% of patients. Thirty-four percent of the patients had malignant portal thrombosis and four patients had metastases. Thirty-eight percent of the patients had received previous treatment. The median follow-up was 9.2 months and 1- and 2-year survival was 46% and 17.5%, respectively. Poor survival was associated with male sex, alpha-fetoprotein values of > 400 ng/ml, albumin levels of < 3 g/dl, and metastases. Independent predictors identified by multivariate Cox regression analysis were male sex, albumin levels of < 3 g/dl, and alpha-fetoprotein values of > 400 ng/ml. The median survival in patients with two or more independent factors was significantly lower than that in patients with none or only one factor (14.2 vs. 4.1 months). CONCLUSION: Survival in patients with non-active treatment of hepatocellular carcinoma can be estimated and the factors involved allow separate groups of patients with different short- to medium-term prognoses to be identified.

Factores pronósticos en pacientes con carcinoma hepatocelular desestimado para tratamiento / Prognostic factors in patients with non-active treatment of hepatocellular carcinoma

Objetivo: Evaluar los factores pronósticos relacionados con la supervivencia de los pacientes con carcinoma hepatocelular (CHC) desestimados para el tratamiento activo. Material y métodos: Entre mayo de 2003 y junio de 2005 se desestimaron 50 pacientes para el tratamiento curativo o paliativo del CHC, según los criterios de la Clasificación de Barcelona, y desde ese momento se realizó un soporte sintomático. Se valoraron los factores pronósticos independientes de la mortalidad mediante curvas de Kaplan-Meier, comparadas a través del test de rangos logarítmicos, y posteriormente mediante análisis de regresión de Cox. Resultados: La edad media fue de 65,9 ± 11,9 años y el 84% eran varones. El 48% de los pacientes tenían hepatitis C, y el 58% tenían un grado A de Child-Pugh. El CHC era multinodular en el 54% de los pacientes, y en el 90% el tamaño tumoral total fue mayor de 5 cm. El 34% presentaba una trombosis portal maligna y 4 pacientes, metástasis. El 38% había sido tratado previamente a su desestimación. La mediana de seguimiento fue de 9,2 meses, y la supervivencia a 1 y 2 años fue del 46 y del 17,5%, respectivamente. Los factores asociados a una mayor mortalidad fueron los siguientes: sexo masculino, alfafetoproteína > 400 ng/ml, albúmina sérica < 3 g/dl y presencia de metástasis. Se identificaron los siguientes factores pronósticos independientes de la mortalidad: sexo masculino, albúmina < 3 g/dl y alfafetoproteína > 400 ng/ml. La mediana de supervivencia de los pacientes sin ninguno o un factor de mortalidad fue claramente superior respecto a los pacientes con 2 o más factores (14,2 frente a 4,1 meses). Conclusión: La supervivencia de los pacientes desestimados para el tratamiento activo del CHC puede ser estimada, y los factores implicados permiten separar grupos de pacientes con diferente pronóstico a corto-medio plazo

Objective: To evaluate factors associated with poor survival in patients with non-active treatment of hepatocellular carcinoma (HCC). Material and Methods: Between May 2003 and June 2005, 50 patients with HCC were deemed unsuitable for active treatment, following the Barcelona Clinic Liver Cancer staging system. Symptomatic treatment was provided. Kaplan-Meier curves were constructed and compared by the log-rank test to identify factors associated with poor survival. Independent factors predictive of survival were evaluated by multivariate Cox regression analysis. Results: The mean age was 65.6 ± 11.9 years and 84% of the patients were men. Forty-eight percent of the patients had hepatitis C infection and 58% were Child-Pugh grade A. HCC was multinodular in 54% and the total tumor size was more than 5 cm in 90% of patients. Thirty-four percent of the patients had malignant portal thrombosis and four patients had metastases. Thirty-eight percent of the patients had received previous treatment. The median follow-up was 9.2 months and 1- and 2-year survival was 46% and 17.5%, respectively. Poor survival was associated with male sex, alpha-fetoprotein values of > 400 ng/ml, albumin levels of < 3 g/dl, and metastases. Independent predictors identified by multivariate Cox regression analysis were male sex, albumin levels of < 3 g/dl, and alpha-fetoprotein values of > 400 ng/ml. The median survival in patients with two or more independent factors was significantly lower than that in patients with none or only one factor (14.2 vs. 4.1 months). Conclusion: Survival in patients with non-active treatment of hepatocellular carcinoma can be estimated and the factors involved allow separate groups of patients with different short- to medium-term prognoses to be identified