Comparison of cancer care for hepatocellular carcinoma at two tertiary-care referral centers from high and low endemic regions for viral hepatitis.
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.
Alsohaibani
Fahad
F
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Porter
Geoffrey
G
Al-Ashgar
Hamad
H
Walsh
Mark
M
Berry
Robert
R
Molinari
Michele
M
Peltekian
Kevork Minas
KM
D000368:Aged; D002173:Cancer Care Facilities; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification; D006509:Hepatitis B / Q000150:complications* / Q000473:pathology / Q000821:virology; D006515:Hepatitis B virus / Q000302:isolation & purification; D006526:Hepatitis C / Q000150:complications* / Q000473:pathology / Q000821:virology; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000473:pathology / Q000821:virology; D008113:Liver Neoplasms / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D005791:Patient Care; D011379:Prognosis; D015996:Survival Rate
World J Gastroenterol. 2010 Jul 21;16(27):3450-6
20632451
Cancer. 2005 Apr 1;103(7):1408-14
15744746
J Hepatobiliary Pancreat Surg. 1998;5(1):14-7
9683748
N Engl J Med. 1999 Mar 11;340(10):745-50
10072408
Ann Intern Med. 2001 Jul 17;135(2):112-23
11453711
Ann Oncol. 1997 Feb;8(2):117-36
9093719
Lancet. 2002 May 18;359(9319):1734-9
12049862
Hepatology. 2001 Jan;33(1):62-5
11124821
Liver Int. 2006 Feb;26(1):55-61
16420510
Hepatology. 2000 Apr;31(4):840-5
10733537
Int J Cancer. 2001 Oct 15;94(2):153-6
11668491
Lancet. 1985 Jun 15;1(8442):1357-60
2861313
Hepatology. 1999 Mar;29(3):664-9
10051466
J Hepatol. 1995 May;22(5):522-6
7650331
Hepatology. 2005 Apr;41(4):707-16
15795889
Best Pract Res Clin Gastroenterol. 2005 Feb;19(1):3-23
15757802
Semin Liver Dis. 1999;19(3):329-38
10518312
Oncology. 2010 Jul;78 Suppl 1:167-71
20616600
Lancet. 1998 Jul 4;352(9121):17-20
9800740
Hepatology. 2005 Nov;42(5):1208-36
16250051
Gastroenterology. 2004 Nov;127(5 Suppl 1):S126-32
15508076
Cancer. 1985 Aug 15;56(4):918-28
2990661