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Hepatocellular carcinoma: prognosis and risk factors
Last reviewed: 23.04.2024
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The prognosis for hepatocellular carcinoma is usually extremely unfavorable. The time interval between infection with HBV or HCV and the development of the tumor varies from several years to many decades.
The growth rate of the tumor can be different and correlates with the survival rate. In Italy, patients with asymptomatically developing hepatocellular carcinoma had a 2-fold increase in tumor volume from 1 to 19 months, averaging 6 months. In Africans, the tumor is characterized by faster growth. The reasons for this phenomenon are not precisely established; perhaps it is genetically predetermined or caused by eating disorders, ingestion of aflatoxin or late diagnostics associated with a frequent change of residence for South African miners.
For small tumors (diameter less than 3 cm in diameter), the annual survival rate is 90.7%, the 2-year period is 55% and the 3-year survival is 12.8%. With a massive infiltrative form of cancer, the forecast is worse than with a nodal one. The presence of an intact capsule is a favorable symptom. Although cirrhosis of the liver is a major risk factor for hepatocellular carcinoma, large regeneration sites (diameter not less than 1 cm) and hypoechoic regenerative sites are especially prone to malignancy.
There is a correlation between the severity of liver disease and the risk of developing hepatocellular carcinoma. Patients with hepatocellular carcinoma under the age of 45 years live longer than elderly patients. Infiltration of the tumor with more than 50% of the liver, a decrease in serum albumin to 3 g% or less, and an increase in serum bilirubin levels are threatening signs.
The risk of developing hepatocellular carcinoma is higher in patients with serum HBsAg or anti-HCV.
The combination of factors is important in increasing the risk of developing cirrhosis. It was believed that in endemic areas the risk of hepatitis transformation into cirrhosis and the development of hepatocellular carcinoma increased with infection of both HBV and HCV. This opinion was mainly based on the use of tests of the first generation. In a study of specific viral markers (HCV-RNA and HBV-DNA) performed in Spain, it was shown that only 9 of 63 patients with hepatocellular carcinoma had co-infection with HBV and HCV. In the United States, HCV and HBV coinfection was detected in 15% of patients with hepatocellular carcinoma. The literature data on the effect of alcohol on the development of hepatocellular carcinoma in patients with liver cirrhosis (caused by HCV infection) are contradictory: either this effect is minimal, or alcohol consumption increases the risk of developing hepatocellular carcinoma.
Metastases in the lungs reduce the survival rate of patients.
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