Investigation of factors affecting prognosis in patients with hepatocellular carcinoma

Purpose: Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and accounts for a significant proportion of global cancer mortality. Several risk factors such as chronic viral hepatitis, cirrhosis, alcohol abuse and metabolic disorders play a role in the development of the disease. The prognosis varies depending on the tumor stage, general condition of the patient and the treatment administered. The aim of this study was to analyze the clinical and demographic characteristics of patients diagnosed with HCC at Dicle University Faculty of Medicine, to determine the factors affecting survival and to compare the findings with the current literature. Method: In our study, a total of 160 patients who were admitted to the Gastroenterology and Oncology Departments of Dicle University Faculty of Medicine between January 2014 and December 2024 and diagnosed with hepatocellular carcinoma based on histopathologic or clinical/radiologic findings were evaluated retrospectively. This study included individuals between the ages of 18 and 90 who were diagnosed with hepatocellular carcinoma (HCC) at the Gastroenterology or Oncology Departments of Dicle University Faculty of Medicine. The basic condition for participation in the study was that the participants did not have any additional malignant neoplasm diagnosis other than HCC. Patients who did not meet these criteria were excluded from the study. Findings: The mean age was 58.79±12.02 years and the mean body mass index was 24.67±3.48 kg/m². Gender distribution was predominantly male and the male/female ratio was 7/1. When the etiologic distribution of the patients evaluated within the scope of the study was analyzed, it was determined that hepatitis B virus (HBV) infection was the most common cause and constituted 60.6% of the cases. HBV was followed by hepatitis C virus (HCV) with 8.1%, hepatitis D virus (HDV) with 7.5%, non-alcoholic steatohepatitis (NASH) with 2.5%, alcohol-related liver disease with 1.9%, Budd-Chiari syndrome with 1.3%, primary biliary cholangitis (PBC) with 0.6% and Wilson's disease with 0.6%. Cryptogenic cases constituted 16.9% of the total patient group. This distribution reveals that the etiologic spectrum of hepatocellular carcinoma is broad and viral hepatitis is among the main causes. BLCL stage was found to be stage A in 10%, stage B in 12.5%, stage C in 55% and stage D in 22.5% of the patients. The mean Child Pugh score of the patients was 7.02±1.75 at baseline and 11.04±2.58 at the last evaluation; the mean MELD score was 10.63±3.93 at baseline and 23.07±9.85 at the last evaluation. In addition, the fact that a significant proportion of patients were in BCLC C stage at the time of diagnosis points to the high rate of advanced stage diagnosis and the prevalence of the need for systemic treatment. In our study, most of the patients received systemic treatment The treatments received by the patients were evaluated in a multidimensional manner. In this context, the proportion of patients who underwent liver transplantation was 6.9% and the proportion of patients who underwent surgical resection was 6.9%. The proportion of patients who underwent local ablation treatment was 10.6%, and the proportion of patients who underwent (TACE, TARE, SBRT) was 14.4%. The proportion of patients who received systemic treatment was 67.5%, immunotherapy was 9.4% and radiotherapy was 8.8%. Results: n this study, we analyzed the clinical, biochemical, radiological and prognostic features of patients with hepatocellular carcinoma. The findings show that cirrhosis, chronic HBV/HCV infections and metabolic factors are the main etiologic determinants. Tumor invasion, vascular invasion, high AFP levels and impaired liver function tests were associated with poor prognosis. Systemic therapy is prioritized due to the frequency of advanced stage at the time of diagnosis. The results suggest that individualized and multidisciplinary approaches play a fundamental role in the management of HCC. Keywords: Hepatocellular carcinoma, etiological factors, prognostic factors.