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SURVIVAL DIFFERENCE BETWEEN SURGERY VERSUS NON-SURGERY FOR THE TREATMENT OF HEPATOCELLULAR CARCINOMA PATIENTS AT HOSPITAL SELAYANG. Azmawati MN 1 , Azmi MT 1 & Krishnan M 2 1 Department of Community Health, UKM Medical Centre, 2 Department of Surgery, Hospital Selayang.

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Azmawati mn 1 azmi mt 1 krishnan m 2

SURVIVAL DIFFERENCE BETWEEN SURGERY VERSUS NON-SURGERY FOR THE TREATMENT OF HEPATOCELLULAR CARCINOMA PATIENTS AT HOSPITAL SELAYANG.

Azmawati MN1, Azmi MT 1& Krishnan M 2

1 Department of Community Health, UKM Medical Centre, 2 Department of Surgery, Hospital Selayang

DEPARTMENT OF COMMUNITY HEALTH, PPUKM


Contents

CONTENTS

  • Introduction

  • Literature review

  • Justification of study

  • Objective

  • Methodology

  • Results

  • Discussion

  • Conclusion

DEPARTMENT OF COMMUNITY HEALTH, PPUKM


Introduction

INTRODUCTION

  • HCC was increasing trend as well the mortality

  • 6% from all cancers worldwide

    (Parkin et al,2000)

  • Malaysia: 2.8 cases per 100,000 populations

    • 5.6% of all cancers, 8.1% of all cancer related death(National Cancer Registry,2003)

  • Hepatic resection: the only treatment offers long term survival in the past decade for HCC patients (Fan et al, Torzilli et al, Fong et al(1999)

  • Non-surgery therapeutic options available (RFA, PEI, TACE)

DEPARTMENT OF COMMUNITY HEALTH, PPUKM


Literature review

LITERATURE REVIEW

Child Pugh Class

Tumor size

Nu. Of Nodules

: Choice of treatment

: Affect survival


Justification of study

JUSTIFICATION OF STUDY

DEPARTMENT OF COMMUNITY HEALTH, PPUKM


Objectives

OBJECTIVES

  • To compare the survival between patients receiving and not receiving surgery

  • To determine the 1,3 and 5 years overall survival for surgery and non-surgery

  • To determine the survival of patients who received different types of treatment according to demography factors and stage of cancer

DEPARTMENT OF COMMUNITY HEALTH, PPUKM


Research framework

RESEARCH FRAMEWORK

Child Pugh Class

Tumor size

Nu. Of Nodules

Surgery

Non-Surgery

Age

Gender

Ethnic

Alcohol intake

Hepatitis status

DEPARTMENT OF COMMUNITY HEALTH, PPUKM


Methodology

METHODOLOGY

-Chi-square test

-Kaplan-Meier

-Log rank test

-Cox’s Regression model


Results

RESULTS

  • Sample size :

    210 HCC patients involved

DEPARTMENT OF COMMUNITY HEALTH, PPUKM


Surgery vs non surgery

Surgery vs Non-surgery

P<0.001


Choice of surgery

Choice of Surgery

Not Significant:

Age

Gender

Ethnic

Hepatitis status

Tumor size

No: 60.5%

Yes: 45.3%

P = 0.03

A: 65.6% B: 40%

C: 0%

<3: 59%

≥ 3: 36.4%

p < 0.001

p = 0.007


Univariate analysis of survival

Univariate Analysis of Survival


Subgroup analysis

Subgroup Analysis


Prediction model for overall hcc patients

Prediction Model For Overall HCC Patients

DEPARTMENT OF COMMUNITY HEALTH, PPUKM


Prediction model for hcc 4cm

Prediction Model For HCC < 4cm

DEPARTMENT OF COMMUNITY HEALTH, PPUKM


Prediction model for hcc 4cm1

Prediction Model For HCC ≥ 4cm

DEPARTMENT OF COMMUNITY HEALTH, PPUKM


Discussion

DISCUSSION

  • Options of treatment mostly depends on tumor stage and Surgeon decision( surgery will be choice: absent of alcohol intake, Child Pugh A, < 3 nodules)

  • Surgery has improved survival:

    • 43 mths vs 20 mths, agreed by Farinati et al(2001), Livraghi et al(1995)

    • Malaccio et al(2005), Atsushi et al(2008): not agreed, small sample size

    • Surgical resection: remove the entire cancer cell

    • Non-Surgery: Will need a repeating procedure, time taken longer will lead to shorter survival duration


Discussion cont

DISCUSSION(cont…)

PREDICTION MODEL

Jeromy et al(2004)Farinati et al(2001),

Livraghiet al(1995)

Jeromy et al(2004)

Tito et al(1995)

Alfredo et al(2008)


Conclusion

CONCLUSION

  • Surgery will remain a best option in HCC patients as overall

  • Small size HCC: non-surgery will give benefit in survival

  • Prediction model will help the Surgeon to choose treatment depends on Child Pugh Class, tumor size and number of nodules involved

  • Public health concern:

    • Primary prevention : education, promotion, emphasize

    • Secondary prevention: early detection, early treatment

    • Tertiary prevention: important of regular follow up after treatment


References

REFERENCES

  • Farinati, F, Gianni,S , Marin, Fagiuoli, S , Rinaldi, M , Naccarato, R. Does the choice of treatment influence survival of patients with cmallHepatocelullar Cancer in compensated cirrhosis?. Lippincott Wiliams& Wilkins 13: 1217-1224(2001)

  • Livraghi,T., Bolondi, L., Buscarini, L., Cottone, M., Mazziotti, A., Morabito, A. &Torzilli, G. No treatment, resection and ethanol injection in Hepatocelullar Cancer : a retrospective analysis of survival in 391 patients with cirrhosis. Italian Cooperative HCC Study Group. Journal of Hepatology 22(5):522-6(1995)

  •   Maluccio, M., Covey, A. M.,Gandhi, R., Gonen, Mithat., Getrajdman, G. I. et al. Comparison of Survival Rates after TransArterialEmbolization and Ablation Versus Surgical Resection for Treating Solitary Hepatocellular Carcinoma up to 7 cm. Journal Of vascular and interventionalradiology 16(7): 955-961(2005)

  •   Atsushi, N., Junichi, M., Satoshi, M., Yorihisa, S., Takashi, N., Kenji, T.,Shigekazu, H., Terumitsu, S. & Takeshi, N. Selection of treatment modality for hepatocellular carcinoma according to the modified Japan Integrated Peringkat score. World Journal Gastroenterology 14(1): 58-63(2008)

  •  Jerome H.L, Pauline W.C, Steven M.A, Ronald W.B, & Clifford Y.K Surgery for Hepatocellular Carcinoma: Does It Improve Survival? Annals of Surgical Oncology, 11(3):298–303(2004)

  •   Tito L, Luigi B, Luigi B, Mario C, Alighieri M, Alberto M et al. No treatment, resection and ethanol injection in hepatocellular carcinoma: a retrospective analysis of survival in 391 patients with cirrhosis. J Hepatol 22:5(1995)

  •  Alfredo G, Andrea R, Alessandro V, Silvia P, Tommaso C, Mirko D et al.Radiofrequency Ablation Versus Surgical Resection for the Treatment of Hepatocellular Carcinoma in Cirrhosis.JGastrointestSurg 12:192–198(2008)Parkin DM, Bray F, Ferlay J &Pisani P. Estimating the world cancer burden. Inter J Cancer 94: 153– 156 (2000)

  • National Cancer Registry. The first report of the National Cancer registry cancer incidence in Malaysia. Kuala Lumpur: Ministry of Health (2001) . Fan ST, Lo CM, Liu CL, et al. Hepatectomy for hepatocellular carcinoma toward zero hospital deaths. Ann Surg 229:322– 30(1999)

  •   Torzilli G, Makuuchi M, Inoue K, et al. No mortality liver resection for hepatocellular carcinoma in cirrhotic and non cirrhotic patients: is there a way? A prospective analysis of our approach. Arch Surg134:984 –92(1999)

  • Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a western center. Ann Surg 229:790 – 800(1999)

DEPARTMENT OF COMMUNITY HEALTH, PPUKM


Azmawati mn 1 azmi mt 1 krishnan m 2

DEPARTMENT OF COMMUNITY HEALTH, PPUKM


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