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Comparison of Cancer Care for Hepatocellular Carcinoma at Two Tertiary-Care Referral Centers from High and Low Endemic Regions for Viral Hepatitis

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Abstract

Background

Risk factors for hepatocellular carcinoma (HCC) have geographic variability but differences in care have not been described. We reviewed the presentation, management, and outcomes of HCC patients from two tertiary-referral centers in Central Saudi Arabia and Atlantic Canada during 1997–2002.

Methods

Data were extracted from health records of 96 Saudi and 80 Canadian consecutive patients with HCC.

Results

Mean age (±SEM) of the two groups were similar (64 + 1 and 65 + 1 years) with 93% versus 75% males amongst Canadian and Saudi patients, respectively. In Canada, underlying disease was alcohol-related cirrhosis (45%), cryptogenic cirrhosis (26%), or hepatitis C (13%). For Saudis, HCC cases were attributed to hepatitis C (47%), cryptogenic cirrhosis (27%), and hepatitis B (21%). At initial presentation, Saudi patients had more vascular invasion and distant metastases while Canadians had more advanced liver disease. The tumor-specific prognostic classifications were comparable. Due to center-specific expertise or preference, symptomatic treatment was more common amongst Saudi patients (83% versus 42%) while more Canadians underwent local palliative interventions (52% versus 12%). Frequency of potentially curative therapies including resection and transplantation were similar at both centers. There was no difference in overall median survival (14 versus 10 months) amongst Canadian and Saudi patients.

Conclusions

This study validates divergence in HCC presentation between low and high endemic regions for viral hepatitis. In addition, for the first time, differences in cancer care of HCC are documented.

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Abbreviations

HCC:

Hepatocellular carcinoma

QEII:

Queen Elizabeth II Health Science Centre

KFSH:

King Faisal Specialist Hospital and Research Center

ASR:

Age standardized rate

ICD:

International Classification of Disease

AFP:

α-Fetoprotein CTP, Child–Turcotte–Pugh

CLIP:

Cancer of the Liver Italian Program

BCLC:

Barcelona Clinic Liver Cancer

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

TACE:

Trans-arterial chemo-embolization

PILI:

Percutaneous intra-lesional injection

IQR:

Inter-quartile range

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Authors and Affiliations

  1. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

    Fahad Alsohaibani & Kevork Minas Peltekian

  2. Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Fahad Alsohaibani & Hamad Al-Ashgar

  3. Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada

    Geoffrey Porter, Mark Walsh, Michele Molinari & Kevork Minas Peltekian

  4. Cancer Care Nova Scotia, Halifax, Nova Scotia, Canada

    Geoffrey Porter

  5. Atlantic Multi-Organ Transplantation Program, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada

    Mark Walsh, Michele Molinari & Kevork Minas Peltekian

  6. Department of Diagnostic Imaging, Dalhousie University, Halifax, Nova Scotia, Canada

    Robert Berry

  7. Atlantic Hepatology Services, P. O. Box 60010, B3H 4R7, Halifax, Nova Scotia, Canada

    Kevork Minas Peltekian

Authors
  1. Fahad Alsohaibani
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  2. Geoffrey Porter
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  3. Hamad Al-Ashgar
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  4. Mark Walsh
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  5. Robert Berry
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  6. Michele Molinari
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  7. Kevork Minas Peltekian
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Corresponding author

Correspondence to Kevork Minas Peltekian.

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Alsohaibani, F., Porter, G., Al-Ashgar, H. et al. Comparison of Cancer Care for Hepatocellular Carcinoma at Two Tertiary-Care Referral Centers from High and Low Endemic Regions for Viral Hepatitis. J Gastrointest Canc 42, 228–235 (2011). https://doi.org/10.1007/s12029-010-9200-x

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  • DOI: https://doi.org/10.1007/s12029-010-9200-x

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