Clinical characteristics and outcomes of patients with hepatocellular carcinoma treated at a large multidisciplinary clinic in Saudi Arabia

Hepatocellular carcinoma (HCC) is the fourth most common solid tumor affecting adult males in Saudi Arabia and the condition poses a serious health threat to patients affected. Here we describe the patient population referred to a large multidisciplinary (MDT) HCC clinic at a tertiary cancer center in Riyadh, Saudi Arabia.

This retrospective review was done to all patients with HCC referred to our MDT clinic in the last 5 years. Demographics, and patient, as well as disease characteristics have been collected. Therapies given such as locoregional, and/or systemic therapies have also been collected. Potential prognostic factors for response and survival such as neutrophil to lymphocyte ratio, sarcopenia, and others have been investigated. Chi square and Fishers Exact test were used for categorical variables.

Total of 670 patients have been referred to the MDT clinic with males representing the majority at 69%. All patients have had a radiological diagnosis of HCC except 7% of cases who needed a biopsy to confirm the diagnosis. The majority of cases had Child-Pugh class A disease (44%) followed by child B class (28%) with the rest having class C. High alpha feto protein (AFP) levels (>400ng/mL) is found in 28% of patients. Etiology of HCC was varied among the cohort with viral hepatitis affecting 37% of, and NASH affecting 6% of the patients. Vascular invasion with tumor thrombosis affected 22%, and extra hepatic metastases affected 16% of the population. Transarterial chemo-embolization was performed 153 times, whereas transarterial radioembolization was performed 74 times. Systemic therapy was given to 153 patients (23%) and of those the majority received Atezolizumab Bevacizumab as first-line therapy (35 patients; 23%). NLR when high (chosen cut off >3) was associated with reduced one year survival with 63% of patients (with high NLR values) surviving less than one year (p 400ng/mL), the majority of patients (72%) will likely survive less than one year (p < 0.001). Patients with sarcopenia and receiving immune checkpoint inhibitors were more likely to have progressive disease (PD) on imaging as per iRECIST (with 65% of sarcopenic patients having iPD) however this association was not statistically significant.

NLR values, locoregional therapy, and AFP levels were found to be strongly prognostic in our studied population. A significant proportion of patients in our MDT clinic have an advanced child pugh score rendering them not fit for systemic therapy. Educating referring physicians about the importance of early referral to an HCC MDT clinic is essential.

The authors.

Has not received any funding.

M. Arabi: Advisory / Consultancy: SIRtex. All other authors have declared no conflicts of interest.