George Fotopoulos, Noha Rashad, George Pentheroudakis, Fatma Aboulkassem, Hussein Khaled and Nicholas Pavlidis
Background: In order to elucidate potential differences in the natural history, clinical presentation and prognosis of patients with hepatocellular carcinoma (HCC) from two different continents, we studied demographics, management and outcome data of two groups of patients from Egypt and Greece. To our knowledge this is the first study to do so.
Patients and Methods: Record-based data from one hundred and five Egyptian and seventy eight Greek patients with HCC, were retrieved and analyzed for demographic, tumor and disease characteristics as well as for treatment and prognostic features.
Results: Median age at HCC diagnosis was 61 years for Egyptians and 70.5 years for Greeks (p<0.05). Positive serology hepatitis C virus (HCV) status was seen in 69% vs. 8% and HBV status in 7% vs. 20% of Egyptian and Greek patients, respectively (p<0.05 and p<0.011). Alcoholic cirrhosis was present in 52% of Greek patients and in none of the Egyptian patients. Median time of preexisting liver disease was 40 months for Egyptians and 12 for Greeks, while the incidence of cirrhosis was 85% vs. 52%,respectively (p<0.05). The Egyptian population showed more diffuse type of HCC in imaging studies (p<0.009) and more frequent occurrence of hepatic biochemical abnormalities (p<0.003-0.007). Regarding systemic dissemination, the Egyptian group had a predilection for bone metastases, whereas the Greek group for visceral metastases (p<0.02). Interestingly, lymph nodal involvement was a harbinger of metastatic dissemination in the Greek, but not in the Egyptian population (p=0.023). No statistical difference in overall survival between the two ethnic groups was found.
Conclusions: In a record based group study, substantial differences emerged between an Egyptian and a Greek population in terms of the etiological factors of HCC (infectious vs. alcoholic), the radiological and biochemical pattern of involvement and the pattern of metastatic dissemination. Further epidemiologic and molecular studies may provide insights into interpretation of these discrepancies.
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