Hepatocellular carcinoma in Lebanon: Etiology and prognostic factors associated with short-term survival.
OBJECTIVE
To study the epidemiology of HCC in Lebanon and prognostic factors predictive of early mortality.


METHODS
An observational follow-up cohort study of HCC cases diagnosed over a five-year period was carried out. Multivariate analysis was conducted to identify prognostic factors in comparison to Cancer of the Liver Italian Program (CLIP) score. Multiple variables including the etiology of underlying liver disease, the demographic characteristics of patients, and the severity of liver disease evaluated by the Child-Pugh score were studied. Tumor parameters included the time of diagnosis of HCC, alpha-fetoprotein level, number and size of nodules, presence of portal vein thrombosis, and treatment modalities. Death or loss of follow-up was considered as an end-point event.


RESULTS
Ninety-two patients (mean 60.5 +/- 22.3 years) were included. Etiology of underlying disease was hepatitis B, C, and alcohol in 67%, 20%, and 23.5% respectively. Child-Pugh class at diagnosis was A, B, and C in 34.8%, 39.3% and 25.8% respectively. Overall survival was 44.8%, 32.8% and 17.6% at 1, 2 and 3 years respectively (mean F/U 40.2 +/- 23.5 mo). Multivariate analysis identified three predictors of early mortality (< 6 mo): bilirubin > 3.2 mg/dL (P < 0.01), HCC as first presentation of liver disease (P = 0.035), and creatinine > 1 mg/dL (P = 0.017). A score based on these variables outperformed the CLIP score by Cox proportional hazard. ROC curve showed both models to be equivalent and moderately accurate.


CONCLUSIONS
HBV is the leading cause of HCC in Lebanon. Independent predictors of early mortality are elevated bilirubin, creatinine and HCC as first manifestation of disease. Prospective validation of a score based on these clinical parameters in predicting short-term survival is needed.
Yaghi
Cesar
C
Service de Gastroenterologie, Hotel Dieu de France University Hospital, beirut, Lebanon.
Sharara
Ala-I
AI
Rassam
Paul
P
Moucari
Rami
R
Honein
Khalil
K
BouJaoude
Joseph
J
Slim
Rita
R
Noun
Roger
R
Abdul-Baki
Heitham
H
Khalifeh
Mohamad
M
Ramia
Sami
S
Sayegh
Raymond
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008099:Liver / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000150:complications / Q000821:virology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D015996:Survival Rate
D003404:Creatinine; D001663:Bilirubin