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Risk Factors for Hepatocellular Carcinoma and Its Mortality Rate: A Multicenter Study in Indonesia

Jasirwan COM*, Hasan I, Sulaiman AS, Gani RA, Lesmana CRA, Kurniawan J, Kalista KF and Nababan SH

Background: Hepatocellular carcinoma (HCC) is a rising cause of mortality and a significant burden. Therefore, a population-based cancer registry is an essential element to provide a baseline and comprehensive analysis of the patient's risk factors. We present a multicentre HCC registry at two hospitals in Indonesia.

Methods: We performed a follow up on HCC patients admitted between January 2015 and November 2017 in Cipto Mangunkusumo National General Hospital and Dharmais Hospital, Jakarta, Indonesia. The primary outcome was the patient's death which also was the endpoint of the follow up evaluation. We conducted a multivariate analysis using logistic regression and calculated the odds ratio (OR) with 95% confidence intervals (CIs).

Results: In this study, there were 282 HCC patients and the mean age was 55 ± 12.75 years. As many as 74.8% (211/282) patients were male and hepatitis B virus (HBV) was the most common etiology found (63.1%; 178/282). At the last follow up, 136 (48.2%) patients have died. Mortality rate was not significantly affected by the patient's sex, age, hepatitis etiology, cirrhotic status, nor HCC surveillance. Based on Child-Pugh (CP) classification, the odds increase progressively in CP C patients (OR 1.95; 95% CI 1.08-3.53; p=0.026). The progressive increase was also found in higher Barcelona Clinic Liver Cancer (BCLC) stage of HCC with odds ratio for C and D patients were 3.50 (95% CI 1.18-10.38; p=0.024) and 3.41 (95% CI 1.02-11.41; p=0.047) respectively. Supportive treatment was the most dominant treatment modality with odds ratio 2.17 (95% CI 1.14-4.16; p =0.019) and was found to be associated with HCC mortality rate. The median survival of all patients was 17 months from the date of diagnosis.

Conclusion: Child-Pugh classification, BCLC stage and treatment modality might predict mortality in HCC patients. Other parameters need further evaluation.