Analysis of demographic, clinic, laboratory specialties and treatments ofhepatocellular carcinoma patients who are followed at Akdeniz University Medicine Faculty at last ten years and comparison with literature

Aim: In thıs study, we aimed to investigate demographic, clinic, laboratory specialties and treatments of HCC patients who are took diagnosis and/or followed in our hospital where is tertiary healthcare service and compare with literature. Method: A total of 261 patients who were followed-up between 2006 and 2016 were retrospectively analyzed. The etiologic factors of patients who diagnosed clinically or pathologically were determined. Results: HBV infection was the most common cause with 130 patients (50.2%). 228 patients were male (87.3%), and 33 patients (12.7%) were female. Male / female ratio was 7: 1. Of the 261 HSC patients, 83 (31.8%) were diagnosed with previous liver disease and 178 (68.2%) were concurrent with HCC. CPS staging of cirrhotic patients was 62.9% in group A (n:139), 29.9% in group B (n:6) and 7.2% in group C with 16 patients. In BCLC staging; A total of 76 patients (29%) were diagnosed at BCLC stage C, and 37 patients (28.5%) were diagnosed at BCLC stage D. One patient (0.8%) was found in BCLC stage 0, 9 (6.9%) and 7 patients (5.4%) in stage A and B, respectively. Metastasis was detected at the time of diagnosis in 64 patients (25%). When the parameters affecting the presence of metastasis were analyzed by univariate logistic regression analysis, advanced BCLC staging (p: 0.01), number of tumors over and above three (p <0.001) and serum AFP elevation (p: 0.002) were found to be significant but there was no relationship between sex and age with metastasis. In 66 HSC patients (27.8%), the sAFP level was below the laboratory lower limit of 7 ng / dl, while 97 (40.5%) were below 20 ng / ml in total. When sAFP value and PVT being were examined by logistic regression analysis, it was seen that in patients with HCC with sAFP> 200 ng / dl, the PVT risk was 4.7 times higher than the group with sAFP <20 ng / dL. 66% of our patients (198 patients) were treated and 24% (63 patients) were not treated. There was no significant difference between the curative treatments KCTX and KCR in terms of survival (p: 0,09). According to the BCLC staging, there was no significant difference in survival (p: 0.868) between 15 patients who received TAKE treatment and 14 patients who received Y90 treatment. At the time of diagnosis, only 32 of the 65 patients who met the MILAN criteria had liver transplants. Although the 5-year survival rate of HCC patients with MILAN criteria was 65-78% (140,141) in Europe (ELTR) and America (OPTN), we found 51% in 33 patients' data. Median survival was 11.9 months in our study. 194 (74.3%) of 261 patients died in ten years. Oneyear survival was 32%, three-year survival was 20%, and five-year survival was 16%. Conclusion: It is seen that many of the HCCs in our country are diagnosed in the late period and diagnosis of chronic liver diseases could not been in time. HCC not only contains a cancer but also a complicated disease such as underlying cirrhosis so, this "two-in-one" situation requires the clinical approach be complicated too. Surgeons, medical oncologists, hepatologists, radiologists and pathologists should cooperate with this multidisciplinary approach to determine coordination and the most appropriate treatment for patients. The establishment of national cancer screening programs is also essential for HCC administration. Key Words: Hepatocellular carcinoma, Child-Pugh score, BCLC stage