Risk Factors for Hepatocellular Carcinoma and Its Mortality Rate: A Multicenter Study in Indonesia
Study design and population
We conducted a cohort retrospective data study from two tertiary hospitals (Cipto Mangunkusumo National General Hospital and Dharmais Hospital) between January 2015 to November 2017. There were 282 HCC patients recruited in this study (158 patients from Cipto Mangunkusumo National General Hospital and 124 patients from Dharmais Hospital). The inclusion criterion was a confirmed HCC diagnosis, while patients with other malignancy and incomplete laboratory or clinical data were excluded.
Baseline clinical data was collected at the time of diagnosis. Diagnosis of HCC was confirmed by biopsy and radiology. The specific finding from CT-scan or MRI is hypervascular in arterial phase and washout in venous and delayed phase. From biopsy, we can find a liver cell differentiation and accompanied by tumor tissue stroma consisting of sinusoid-like blood space lined by a layer of endothelial cells. There was no non-liver metastatic incidence observed. Patients were grouped by whether they were diagnosed from routine surveillance or detected from their symptoms. Information on patients' gender, age, hepatitis marker, laboratory data of liver function (albumin, bilirubin, AST, ALT), and clinical conditions (ascites, encephalopathy, the appearance of cirrhosis and portal vein thrombus) were collected. Child Turcotte Pugh (CP) score was calculated from albumin, bilirubin, international normalized ratio (INR), ascites, and encephalopathy and then classified into three following classes: 5-6 score for CP A, 7-9 score for CP B, 10-15 score for CP C. Staging was done using Barcelona Clinical Liver Cancer (BCLC) staging system.
Patients were also separated into three groups based on their treatment modality: curative, palliative, and supportive. The curative protocol consisted of surgical resection and radiofrequency ablation (RFA). The palliative protocol consisted of radiation therapy, transarterial chemo-embolization (TACE), and transarterial chemo-infusion (TACI), sorafenib. Meanwhile, the supportive protocol provided patients with best supportive care therapy.
Patients' death was investigated from their medical records or through contacting the families by phone. If the phone number could not be contacted, the medical team follows up by visiting their home address, providing an assignment letter from the hepatobiliary division.
Journal of Tumor Research