Changes in Presentation, Treatment, and Survival of Patients with Hepatocellular Carcinoma in Damietta, Egypt, 2007-2019: A Retrospective Monocentric Cohort Study

Kévin Jean; Ahmed Tawheed; Liem Binh Luong Nguyen; Tarek Heikal; Usama Eldaly; Neveen Elhadidy; Ahmed Elghaieb; Ahmed Aboudonia; Laura Tondeur; Amélie Dublineau; Arnaud Fontanet; Mohamed El-Kassas

doi:10.2147/JHC.S391511

Changes in Presentation, Treatment, and Survival of Patients with Hepatocellular Carcinoma in Damietta, Egypt, 2007-2019: A Retrospective Monocentric Cohort Study

J Hepatocell Carcinoma. 2023 Jan 25:10:99-111. doi: 10.2147/JHC.S391511. eCollection 2023.

Authors

Kévin Jean^{1

2}, Ahmed Tawheed³, Liem Binh Luong Nguyen⁴, Tarek Heikal⁵, Usama Eldaly⁵, Neveen Elhadidy⁶, Ahmed Elghaieb⁷, Ahmed Aboudonia⁷, Laura Tondeur¹, Amélie Dublineau⁴, Arnaud Fontanet^{2

4}, Mohamed El-Kassas³

Affiliations

¹ Laboratoire MESuRS, Conservatoire national des arts et métiers, Paris, France.
² Unité PACRI, Institut Pasteur, Conservatoire national des arts et métiers, Paris, France.
³ Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
⁴ Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris-Cité, Paris, France.
⁵ Medical Oncology Department, Damietta Oncology Center, Damietta, Egypt.
⁶ Pharmaceutical Services Department, Damietta Oncology Center, Damietta, Egypt.
⁷ Radiology Department, Damietta Oncology Center, Damietta, Egypt.

Abstract

Introduction: We aimed to assess temporal changes in the presentation and survival of patients with hepatocellular carcinoma (HCC) in the northern Egypt region, one of the regions reporting the highest incidence of the disease globally.

Methods: We conducted a monocentric retrospective study. Patients presenting at the Damietta Oncology referral center between 2007 and 2019 with a diagnosed HCC were eligible. Individual, clinical and tumor characteristics at HCC diagnosis, including the Barcelona Clinic Liver Cancer (BCLC) staging, were retrieved from medical files and patients' final vital status was ascertained by combining various data sources. Patients were divided into 2 groups based on diagnosis period: pre- and post-2014. Survival was analysed based on Kaplan-Meier curves and differences in restricted mean survival time (RMST).

Results: Data from 5097 patients (among 5210 eligible, 97.8%) were analyzed. We observed a significant trend toward HCC diagnosed at earlier stage in the post- vs pre-2014 period (BCLC stage 0/A or B: 37.2% vs 27.1%, p<10^-3). Overall patient's survival after the HCC diagnosis was poor, with a median of 8.1 months. The BCLC staging system performed well in predicting survival. Despite a trend toward HCC diagnosed at earlier stages, we did not observe a significant improvement in survival over time. Overall, treatments offered in this medical center were in line with international guidelines, and 16.1% of the patients who received a curative treatment had an improved survival (30.7 months in median). However, HCC recurrence was frequent among patients cured for HCC, with a median time to recurrence of 22 months.

Discussion: Overall survival after HCC diagnosis in Egypt remains poor but is significantly improved by curative therapy. Despite a trend toward earlier diagnosis of HCC, we did not observe a general improvement in survival over time, which remains to be clearly understood.

Keywords: Egypt; epidemiology; hepatocellular carcinoma; liver cancer; staging system; survival.

Grants and funding

This research has been funded by the Pasteur Foundation US. The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the article.