Hepatoselüler karsinomun yönetimi: Tek merkez deneyimi

Hasan Tankut Köseoğlu; Deha Çetin; Diler Taş Kılıç; Mahmut Yüksel; Mevlüt Hamamcı; Orhan Coşkun; Nurettin Suna; Muhammet Yener Akpınar; Mustafa Kaplan; Derya Arı

doi:10.17941/agd.1902920

Araştırma Makalesi

Hepatoselüler karsinomun yönetimi: Tek merkez deneyimi

Yıl 2026, Cilt: 25 Sayı: 1 , 19 - 28 , 21.04.2026

Hasan Tankut Köseoğlu , Deha Çetin , Diler Taş Kılıç , Mahmut Yüksel , Mevlüt Hamamcı , Orhan Coşkun Nurettin Suna , Muhammet Yener Akpınar , Mustafa Kaplan , Derya Arı

https://doi.org/10.17941/agd.1902920

https://izlik.org/JA24TK38FE

Öz

Giriş ve Amaç: Hepatoselüler karsinom, dünya çapında en yaygın kanserlerden biridir ve önemli bir mortalite ve morbidite nedenidir. Etiyolojide en büyük risk faktörü sirozdur. Hepatoselüler karsinom tanısı, laboratuvar ve radyolojik yöntemlerin birlikte kullanılmasıyla birçok hastada biyopsiye gerek kalmadan konulabilir. Tedavi seçimi; karaciğer rezerv durumu, lezyonların boyutu ve sayısı ile invazyon durumu göz önünde bulundurularak planlanır. Bu çalışmada, tek merkezde hepatoselüler karsinom yönetimi deneyimini sunmayı amaçladık. Gereç ve Yöntem: Hepatoselüler karsinomlu hastalar üzerinde retrospektif, gözlemsel, tek merkezli bir çalışma gerçekleştirildi. Hastaların tümöral özellikleri, yönetimi ve sağkalım süreleri tanımlandı. Veri seti SPSS programıyla analiz edildi. Bulgular: 2013-2020 yılları arasında hepatoselüler karsinom tanısı almış, ortanca yaşı 63 olan toplam 164 hasta çalışmaya dahil edildi. Hastaların %59.1'inde kronik hepatit B virüs enfeksiyonu, %21.3'ünde kronik hepatit C virüs enfeksiyonu, %7.9'unda hepatit Delta virüs enfeksiyonu ve %85.4'ünde siroz mevcuttu. On iki hastaya karaciğer nakli yapıldı, 11 hastaya rezeksiyon, 57 hastaya transarteryel kemoembolizasyon, 8 hastaya perkütan etanol enjeksiyonu, 30 hastaya ablasyon uygulandı ve 57 hasta palyatif bakım ile izlendi. Nakil yapılan hastaların tamamı Child A idi. Child A hastalarında palyatif bakım oranı %19.4, Child B hastalarında %50 ve Child C hastalarında %62.5 olarak bulundu. Lezyonları 20 ila 50 mm arasında olan bireylerin %11.8'inde, 50 mm'den fazla olanların ise %32'sinde hepatit B virüs-DNA pozitif bulundu. Lezyonları 50 mm'den büyük olan hastaların %45'i, lezyonları 20 ila 50 mm arasında olan hastaların ise %16'sı palyatif bakım ile izlendi. Sonuç: Tedavi stratejisi lezyonların sayısı, büyüklüğü ve invazyon durumuna göre belirlenir. Bu nedenle hepatit B virüs-DNA'nın yönetimi ve hepatoselüler karsinomanın erken tespiti hastalığın sonlanımı için kritik öneme sahiptir.

Anahtar Kelimeler

Hepatoselüler karsinom , viral hepatit , siroz , karaciğer nakli

Kaynakça

1. Iliescu L, Mindrut E, Grasu M, et al. Management of hepatocellular carcinoma–experience of a single center. Chirurgia (Bucur). 2014;109(2):204-7.
2. Liu TC, Vachharajani N, Chapman WC, Brunt EM. Noncirrhotic hepatocellular carcinoma: derivation from hepatocellular adenoma? Clinicopathologic analysis. Mod Pathol. 2014;27(3):420-32. doi: 10.1038/modpathol.2013.
3. Younossi Z, Stepanova M, Ong JP, et al; Global Nonalcoholic Steatohepatitis Council. Nonalcoholic Steatohepatitis Is the Fastest Growing Cause of Hepatocellular Carcinoma in Liver Transplant Candidates. Clin Gastroenterol Hepatol. 2019;17(4):748-55.e3. doi: 10.1016/j.cgh.2018.05.057.
4. Cha C, Dematteo RP. Molecular mechanisms in hepatocellular carcinoma development. Best Pract Res Clin Gastroenterol. 2005;19(1):25-37. doi: 10.1016/j.bpg.2004.11.005.
5. Calderaro J, Couchy G, Imbeaud S, Amaddeo G, Letouzé E, Blanc JF, et al. Histological subtypes of hepatocellular carcinoma are related to gene mutations and molecular tumour classification. J Hepatol. 2017;67(4):727-38. doi: 10.1016/j.jhep.2017.05.014.
6. Bialecki ES, Di Bisceglie AM. Diagnosis of hepatocellular carcinoma. HPB (Oxford). 2005;7(1):26-34. doi: 10.1080/13651820410024049.
7. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182-236.
8. Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2022;76(3):681-93. doi: 10.1016/j.jhep.2021.11.018.
9. Bosch FX, Ribes J, Borràs J. Epidemiology of primary liver cancer. Semin Liver Dis. 1999;19(3):271-85. doi: 10.1055/s-2007-1007117.
10. Bosetti C, Levi F, Boffetta P, et al. Trends in mortality from hepatocellular carcinoma in Europe, 1980‐2004. Hepatology. 2008;48(1):137-45. doi: 10.1002/hep.22312.
11. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30. doi: 10.3322/caac.21442.
12. Ha J, Yan M, Aguilar M, et al. Race/ethnicity‐specific disparities in cancer incidence, burden of disease, and overall survival among patients with hepatocellular carcinoma in the United States. Cancer. 2016;122(16):2512-23. doi: 10.1002/cncr.30103.
13. Chen CJ, Yang HI, Su J, et al; REVEAL-HBV Study Group. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295(1):65-73. doi: 10.1001/jama.295.1.65.
14. Kanwal F, Singal AG. Surveillance for Hepatocellular Carcinoma: Current Best Practice and Future Direction. Gastroenterology. 2019;157(1):54-64. doi: 10.1053/j.gastro.2019.02.049.
15. Chan SL, Mo F, Johnson PJ, et al. Performance of serum α-fetoprotein levels in the diagnosis of hepatocellular carcinoma in patients with a hepatic mass. HPB (Oxford). 2014;16(4):366-72. doi: 10.1111/hpb.12146.
16. Peng Y, Wei Q, He Y, et al. ALBI versus child-pugh in predicting outcome of patients with HCC: A systematic review. Expert Rev Gastroenterol Hepatol. 2020;14(5):383-400. doi: 10.1080/17474124.2020.1748010.
17. Wang YY, Zhao XH, Ma L, et al. Comparison of the ability of Child-Pugh score, MELD score, and ICG-R15 to assess preoperative hepatic functional reserve in patients with hepatocellular carcinoma. J Surg Oncol. 2018;118(3):440-5. doi: 10.1002/jso.25184.
18. Yeh SH, Li CL, Lin YY, et al. Hepatitis B Virus DNA Integration Drives Carcinogenesis and Provides a New Biomarker for HBV-related HCC. Cell Mol Gastroenterol Hepatol. 2023;15(4):921-9. doi: 10.1016/j.jcmgh.2023.01.001.

Yıl 2026, Cilt: 25 Sayı: 1 , 19 - 28 , 21.04.2026

Hasan Tankut Köseoğlu , Deha Çetin , Diler Taş Kılıç , Mahmut Yüksel , Mevlüt Hamamcı , Orhan Coşkun Nurettin Suna , Muhammet Yener Akpınar , Mustafa Kaplan , Derya Arı

https://doi.org/10.17941/agd.1902920

https://izlik.org/JA24TK38FE

Öz

Background and Aims: Hepatocellular carcinoma is one of the most common cancers worldwide and is a significant cause of mortality and morbidity. Cirrhosis is the greatest risk factor in etiology. Hepatocellular carcinoma diagnosis can be made in many patients without the need for biopsy by using laboratory and radiological methods together. Treatment selection is planned by considering liver reserve status, size and number of lesions, and invasion status. In this study, we aimed to present the experience of hepatocellular carcinoma management in a single center. Materials and Method: We performed a retrospective, observational, single centre study of patients with hepatocellular carcinoma. We defined patients tumoral specialities, management and survival times. The data set was analyzed with SPSS programme. Results: A total of 164 patients diagnosed with hepatocellular carcinoma from 2013 to 2020 were included, with a median age of 63 years. Chronic hepatitis B virus infection was seen in 59.1% of patients, chronic hepatitis C virus in 21.3%, hepatitis Delta virus infection in 7.9%, and cirrhosis in 85.4%. 12 patients underwent liver transplantation, 11 underwent resection, 57 underwent trans-arterial chemoembolization, 8 underwent percutaneous ethanol injection, 30 underwent ablation, and 57 received palliative care. All patients who underwent transplantation were followed up as Child A. The rate of palliative care was 19.4% in Child A patients, 50% in Child B patients, and 62.5% in Child C patients. Hepatitis B virus-DNA was found to be positive in 11.8% of individuals with lesions measuring 20 to 50 mm, and 32% of those measuring more than 50 mm. Palliative care was noted for 45% of patients with lesions larger than 50 mm and 16% of patients with lesions between 20 and 50 mm. Conclusion: The treatment strategy is determined on the number and size of lesions, as well as the stage of the invasion. So the management of Hepatitis B virus-DNA and early detection of hepatocellular carcinoma are critical to the disease's outcome.

Anahtar Kelimeler

Hepatocellular carcinoma , viral hepatitis , cirrhosis , liver transplantation

Kaynakça

1. Iliescu L, Mindrut E, Grasu M, et al. Management of hepatocellular carcinoma–experience of a single center. Chirurgia (Bucur). 2014;109(2):204-7.
2. Liu TC, Vachharajani N, Chapman WC, Brunt EM. Noncirrhotic hepatocellular carcinoma: derivation from hepatocellular adenoma? Clinicopathologic analysis. Mod Pathol. 2014;27(3):420-32. doi: 10.1038/modpathol.2013.
3. Younossi Z, Stepanova M, Ong JP, et al; Global Nonalcoholic Steatohepatitis Council. Nonalcoholic Steatohepatitis Is the Fastest Growing Cause of Hepatocellular Carcinoma in Liver Transplant Candidates. Clin Gastroenterol Hepatol. 2019;17(4):748-55.e3. doi: 10.1016/j.cgh.2018.05.057.
4. Cha C, Dematteo RP. Molecular mechanisms in hepatocellular carcinoma development. Best Pract Res Clin Gastroenterol. 2005;19(1):25-37. doi: 10.1016/j.bpg.2004.11.005.
5. Calderaro J, Couchy G, Imbeaud S, Amaddeo G, Letouzé E, Blanc JF, et al. Histological subtypes of hepatocellular carcinoma are related to gene mutations and molecular tumour classification. J Hepatol. 2017;67(4):727-38. doi: 10.1016/j.jhep.2017.05.014.
6. Bialecki ES, Di Bisceglie AM. Diagnosis of hepatocellular carcinoma. HPB (Oxford). 2005;7(1):26-34. doi: 10.1080/13651820410024049.
7. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182-236.
8. Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2022;76(3):681-93. doi: 10.1016/j.jhep.2021.11.018.
9. Bosch FX, Ribes J, Borràs J. Epidemiology of primary liver cancer. Semin Liver Dis. 1999;19(3):271-85. doi: 10.1055/s-2007-1007117.
10. Bosetti C, Levi F, Boffetta P, et al. Trends in mortality from hepatocellular carcinoma in Europe, 1980‐2004. Hepatology. 2008;48(1):137-45. doi: 10.1002/hep.22312.
11. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30. doi: 10.3322/caac.21442.
12. Ha J, Yan M, Aguilar M, et al. Race/ethnicity‐specific disparities in cancer incidence, burden of disease, and overall survival among patients with hepatocellular carcinoma in the United States. Cancer. 2016;122(16):2512-23. doi: 10.1002/cncr.30103.
13. Chen CJ, Yang HI, Su J, et al; REVEAL-HBV Study Group. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295(1):65-73. doi: 10.1001/jama.295.1.65.
14. Kanwal F, Singal AG. Surveillance for Hepatocellular Carcinoma: Current Best Practice and Future Direction. Gastroenterology. 2019;157(1):54-64. doi: 10.1053/j.gastro.2019.02.049.
15. Chan SL, Mo F, Johnson PJ, et al. Performance of serum α-fetoprotein levels in the diagnosis of hepatocellular carcinoma in patients with a hepatic mass. HPB (Oxford). 2014;16(4):366-72. doi: 10.1111/hpb.12146.
16. Peng Y, Wei Q, He Y, et al. ALBI versus child-pugh in predicting outcome of patients with HCC: A systematic review. Expert Rev Gastroenterol Hepatol. 2020;14(5):383-400. doi: 10.1080/17474124.2020.1748010.
17. Wang YY, Zhao XH, Ma L, et al. Comparison of the ability of Child-Pugh score, MELD score, and ICG-R15 to assess preoperative hepatic functional reserve in patients with hepatocellular carcinoma. J Surg Oncol. 2018;118(3):440-5. doi: 10.1002/jso.25184.
18. Yeh SH, Li CL, Lin YY, et al. Hepatitis B Virus DNA Integration Drives Carcinogenesis and Provides a New Biomarker for HBV-related HCC. Cell Mol Gastroenterol Hepatol. 2023;15(4):921-9. doi: 10.1016/j.jcmgh.2023.01.001.

Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	Türkçe
Konular	Gastroenteroloji ve Hepatoloji
Bölüm	Araştırma Makalesi
Yazarlar	Hasan Tankut Köseoğlu 0000-0002-4819-4460 Deha Çetin 0000-0002-5610-5376 Diler Taş Kılıç 0000-0003-1917-5866 Mahmut Yüksel 0000-0002-4727-2834 Mevlüt Hamamcı 0000-0002-2418-1059 Orhan Coşkun Bu kişi benim Nurettin Suna 0000-0001-6234-7788 Muhammet Yener Akpınar 0000-0003-0903-4664 Mustafa Kaplan 0000-0002-6959-675X Derya Arı 0000-0001-8024-781X
Gönderilme Tarihi	11 Temmuz 2025
Kabul Tarihi	1 Ocak 2026
Yayımlanma Tarihi	21 Nisan 2026
DOI	https://doi.org/10.17941/agd.1902920
IZ	https://izlik.org/JA24TK38FE
Yayımlandığı Sayı	Yıl 2026 Cilt: 25 Sayı: 1

Kaynak Göster

APA	Köseoğlu, H. T., Çetin, D., Taş Kılıç, D., Yüksel, M., Hamamcı, M., Coşkun, O., Suna, N., Akpınar, M. Y., Kaplan, M., & Arı, D. (2026). Hepatoselüler karsinomun yönetimi: Tek merkez deneyimi. Akademik Gastroenteroloji Dergisi, 25(1), 19-28. https://doi.org/10.17941/agd.1902920

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