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Chronic viral hepatitis causing hepatocellular carcinoma in Sri Lanka: a tertiary referral center cohort

Authors:

B K S Bulathsinhala ,

Teaching Hospital, Ragama, LK
About B K S
Professorial Surgical Unit, North Colombo 
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R C Siriwardana,

University of Kelaniya, Ragama, LK
About R C
Department of Surgery, Faculty of Medicine
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M B Gunetilleke,

University of Kelaniya, Ragama, LK
About M B
Department of Surgery, Faculty of Medicine
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M A Niriella,

University of Kelaniya, Ragama, LK
About M A
Department of Medicine, Faculty of Medicine
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A Dassanayake

University of Kelaniya, Ragama, LK
About A
Department of Pharmacology, Faculty of Medicine
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Abstract

Introduction

Hepatocellular carcinoma is increasing globally. Compared to global patterns, hepatitis B and C are rare in Sri Lanka whilst non-alcoholic fatty liver disease (NAFLD) and alcohol are the commonest causes of hepatocellular carcinoma.

Objective

To determine the characteristics of a cohort of Sri Lankan patients with hepatocellular carcinoma of non-viral aetiology.

Methods

Details of 550 consecutive patients with hepatocellular carcinoma referred from 2012 to 2017 were collected prospectively. Demographic data, clinical and biochemical details, aetiology, comorbidities, tumor characteristics and type of treatment offered were retrospectively analyzed.

Results

Median age was 62.9 years (range 12 - 88) with male preponderance (n = 473; 86%).  Overall median BMI was 35.8 kgm-2. Majority (n=309; 56 %) had NAFLD induced cirrhosis, second commonest cause was alcohol (n=203;36.9 %). Tumour was single nodular 233(42.4%) and diffusely infiltrating 92(16.7%). Diagnostic rise in serum alpha-fetoprotein (over 200 micrograms) was seen in 30.2%. Venous invasion was present in 28.5% [portal vein 136 (24.7%), hepatic vein 9 (1.6%) and cava 12(2.2%)]. Extra hepatic tumor spread was seen in 6.9% [lungs 20(3.6%), bones 4(0.7%), peritoneal 6 (1.1%) and metastases at other sites 8 (1.45%)]. Curative surgery was offered in 78(14.2%).  Tumour embolization was done in 192(34.9%), radio frequency ablation 34(6.2%), alcohol injection 42(7.6%) and 204(37.1%) patients were offered palliative care. Overall median survival was 20.6 months.

Conclusion

In a large Sri Lankan cohort, most hepatocellular carcinomas were due to cryptogenic cirrhosis and it was aggressive at presentation. Screening of high-risk NAFLD patients needs to be considered and further palliative care needs to be improved.

DOI: https://doi.org/10.4038/cmj.v63i3.8724
How to Cite: Bulathsinhala, B.K.S., Siriwardana, R.C., Gunetilleke, M.B., Niriella, M.A. and Dassanayake, A., 2018. Chronic viral hepatitis causing hepatocellular carcinoma in Sri Lanka: a tertiary referral center cohort. Ceylon Medical Journal, 63(3), pp.133–138. DOI: http://doi.org/10.4038/cmj.v63i3.8724
Published on 30 Sep 2018.
Peer Reviewed

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