title: Hepatocellular carcinoma in Native South Asian Pakistani population; trends, clinico-pathological characteristics & differences in viral marker negative & viral-hepatocellular carcinoma.
abstract: BACKGROUND
  HCC is the fifth most common cancer globally. Our study was conducted to (1)investigate the trends and clinico-pathological characteristics of Hepatocellular carcinoma among native South Asian patients in Pakistan, (2)to estimate the prevalence as well as the trends of viral marker negative HCC and (3) to compare the clinico-pathological, radiological characteristics, applicability of treatment at diagnosis and prognostic factors among patients with both viral marker negative and viral marker positive-HCC being consulted at Aga Khan University Hospital(AKUH), Karachi, Pakistan.
  
  
  METHODS
  Patients ≥18 years, already diagnosed to have HCC and visiting AKUH during 1999-2009 were identified using ICD code 1550. The diagnosis of HCC was made in the presence of characteristic features of HCC on triple-phasic CT scan/MRI or with histological findings on biopsy.
  
  
  RESULTS
  645 patients were enrolled. Of these 546(84.7%) were viral-HCC and 99(15.3%) were viral marker negative HCC. Among viral-HCC group underlying etiology of cirrhosis was HCV in 67.9%, HBV in 21.8% and concomitant HBV with HCV or HDV in 10.3% cases. Majority (62.8%) patients had advanced HCC. Larger tumor size (p < 0.001), shorter duration between diagnosis of cirrhosis and HCC (p 0.03), concomitant Diabetes Mellitus (p < 0.001) were found significant factors associated with viral marker negative HCC.
  
  
  CONCLUSIONS
  The burden of hepatocellular carcinoma is rising among native South Asian Pakistani population and the viral marker negative HCC are not uncommon in our population. Viral marker negative HCC tend not to be under surveillance as compared to viral-HCC and are diagnosed mostly at advanced stage & when they became symptomatic.
authors.affiliation: Section of Gastroenterology, Department of Medicine, The Aga Khan University & Hospital, Stadium Road, Karachi 74800, Pakistan. amna.subhan@aku.edu
authors.forename: Amna Subhan
authors.initials: AS
authors.lastname: Butt
authors.forename: Saeed
authors.initials: S
authors.lastname: Hamid
authors.forename: Ashfaq Ahmad
authors.initials: AA
authors.lastname: Wadalawala
authors.forename: Mariam
authors.initials: M
authors.lastname: Ghufran
authors.forename: Ammar Asrar
authors.initials: AA
authors.lastname: Javed
authors.forename: Omer
authors.initials: O
authors.lastname: Farooq
authors.forename: Bilal
authors.initials: B
authors.lastname: Ahmed
authors.forename: Tanveer
authors.initials: T
authors.lastname: Ul Haq
authors.forename: Wasim
authors.initials: W
authors.lastname: Jafri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D015415:Biomarkers