Hepatoselüler karsinomun yönetimi: Tek merkez deneyimi

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

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

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