NATURAL-HISTORY OF UNTREATED PRIMARY HEPATOCELLULAR-CARCINOMA - A RETROSPECTIVE STUDY OF 157 PATIENTS

Primary hepatocellular carcinoma (HCC) is a common malignancy with a d ismal prognosis; new modalities of treatment as alternatives to surger y have been developed for unresectable patients. The authors obtain ba seline data for the natural history of HCC so that the efficacy of new treatments may be evaluated. A retrospective study of 157 untreated p atients with tissue-proven or serodiagnosed HCC was conducted. Clinica l characteristics including laboratory investigation, treatment receiv ed, survival from the time of diagnosis, and prognostic factors were e valuated. There were 129 men and 28 women (ratio, 4.6:1). Median age w as 50.9 years (range, 14.1-85.3 years). The most common symptoms and s igns were weight loss (68.2%), abdominal fullness (62.5%), abdominal p ain (51.6%), hepatomegaly (73.7%), ascites (45.2%), and jaundice (40.6 %). Eighteen percent had extrahepatic metastases of which the lungs we re the most common site. Seventy percent were hepatitis B virus relate d. Overall median survival was 8.7 weeks after the time of diagnosis. Survivals by stages were: TNM II, 16.6 weeks; TNM III, 7.3 weeks; TNM IVA, 9.7 weeks; TNM IVB, 7.6 weeks; Okuda II, 10.7 weeks; and okuda II I, 7.3 weeks. Multivariate analysis revealed serum total bilirubin and albumin as independent prognostic factors of survival. Common causes of death were upper gastrointestinal hemorrhage (34.1%), cancer-relate d causes (cachexia, HCC rupture, metastatic disease, 31.8%), and hepat ic failure (25.0%). Patients with HCC were diagnosed at late stages of their disease and the advanced nature of the tumor precluded effectiv e therapy. Earlier tumor detection at a time when patients are better candidates for treatment may be aided by an active surveillance progra m of high risk groups.