Carcinoma hepatocelular: realidade de um serviço publico especializado
Data
2015-10-31
Autores
Carvalho, Sandra Regina de Almeida 
Orientadores
Silva, Ivonete Sandra de Souza e
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: O carcinoma hepatocelular (CHC) é a neoplasia maligna mais comum que se desenvolve em fígados cirróticos e que apresenta características clínicas, epidemiológicas, e taxas de mortalidade diferentes dependendo da região estudada. O objetivo deste estudo foi avaliar o perfil epidemiológico, clínico, laboratorial, terapêutico e a taxa e fatores preditivos de sobrevida em portadores de CHC em um serviço especializado. Material e métodos: foram estudados, de 2000 a 2012, pacientes com diagnóstico de CHC, acompanhados em um serviço público especializado na EPM-UNIFESP. O diagnóstico se baseou em exame de imagem trifásico por tomografia computadorizada (TC) ou ressonância magnética (RNM) ou por biópsia hepática. Avaliação clínica, bioquímica e terapêutica foi realizada em todos os pacientes. Análise de sobrevida se baseou no método de Kaplan-Meier e Regressão de Cox. Resultados: foram estudados 247 portadores de CHC com média de idade de 60±10 anos e predomínio de homens (74%). As etiologias encontradas foram infecção pelo HCV (73%) seguida do consumo abusivo de álcool (12%) e infecção pelo HBV (8%). Cirrose hepática esteve presente em 92% dos pacientes, os quais foram classificados em Child A (57%), B (36%) e C (7%). A mediana dos níveis de AFP foi de 57UI/mL. A média dos valores de MELD foi de 11. A média do número e tamanho de nódulos foram respectivamente 2 nódulos e 5 cm de diâmetro. Estavam dentro dos critérios de Milão 43% dos pacientes. Metástase à distância e invasão vascular tumoral foram encontradas, respectivamente, em 10% e 13% dos casos. Transplante hepático foi realizado em 10% dos casos. O tempo médio de sobrevida global foi de 60 meses com probabilidade de sobrevida em 1, 3 e 5 anos de 74%, 40% e 32%, respectivamente. Preditores independentes de maior chance de óbito foram gênero masculino (P< 0.001), idade avançada (P< 0.004), níveis séricos de alfafetoproteína acima de 20 UI/mL (P< 0.03), valores de RNI mais elevados (P< 0.016) e invasão vascular tumoral (P< 0.004). Preditores independentes de menor chance de óbito foram infecção pelo HCV (P< 0.003) e níveis mais altos de albumina (P< 0.009). Conclusão: Os pacientes com CHC foram na sua maioria mais velhos, homens, com etiologia pelo HCV, função hepática preservada e fora de critérios para tratamento curativo. Contribuíram para mortalidade mais elevada entre os pacientes com CHC o gênero masculino, idade mais avançada, alfafetoproteína elevada, RNI elevado e invasão vascular tumoral. Por outro lado aqueles com infecção pelo HCV tiveram 80% menos chance de óbito que as outras etiologias.
Introduction: Hepatocellular carcinoma (HCC) is characterized by high rates of mortality. The factors associated with patient survival vary according to the geographic region studied. The objective of this study was to evaluate the rate and predictive factors of survival in patients with HCC. Material and methods: Patients diagnosed with HCC between 2000 and 2012, seen at a public tertiary care hospital in Brazil, were studied prospectively. Clinical-demographic, laboratory and tumor characteristics were analyzed. The tumor was diagnosed based on triple-phase imaging by computed tomography or magnetic resonance imaging or liver biopsy. The Kaplan-Meier method and Cox regression were used for survival analysis. Results: A total of 247 patients with HCC were studied. The mean age was 60 ± 10 years and there was a predominance of men (74%). The etiologies were HCV infection (73%), followed by excessive alcohol consumption (12%) and HBV infection (8%). Cirrhosis was present in 92% of cases. The mean MELD score was 11. The mean number and diameter of the nodules were 2 and 5 cm, respectively. Distant metastases and tumor vascular invasion were observed in 10% and 13% of cases, respectively. A liver transplant was performed in 10% of cases. The mean overall survival was 60 months, with a 1-, 3- and 5-year survival probability of 74%, 40% and 32%, respectively. The independent predictors of a higher risk of death were male gender (P < 0.001), advanced age (P < 0.004), serum alpha-fetoprotein levels > 20 IU/ml (P < 0.03), a high INR (P < 0.016), and tumor vascular invasion (P < 0.004). The independent predictors of a lower risk of death included HCV infection (P < 0.003) and elevated albumin levels (P < 0.009). Conclusion: Male gender, advanced age, elevated alpha-fetoprotein, a high INR and tumor vascular invasion contributed to higher mortality among patients with HCC. On the other hand, patients infected with HCV presented an 80% lower risk of death compared to those with other etiologies.
Introduction: Hepatocellular carcinoma (HCC) is characterized by high rates of mortality. The factors associated with patient survival vary according to the geographic region studied. The objective of this study was to evaluate the rate and predictive factors of survival in patients with HCC. Material and methods: Patients diagnosed with HCC between 2000 and 2012, seen at a public tertiary care hospital in Brazil, were studied prospectively. Clinical-demographic, laboratory and tumor characteristics were analyzed. The tumor was diagnosed based on triple-phase imaging by computed tomography or magnetic resonance imaging or liver biopsy. The Kaplan-Meier method and Cox regression were used for survival analysis. Results: A total of 247 patients with HCC were studied. The mean age was 60 ± 10 years and there was a predominance of men (74%). The etiologies were HCV infection (73%), followed by excessive alcohol consumption (12%) and HBV infection (8%). Cirrhosis was present in 92% of cases. The mean MELD score was 11. The mean number and diameter of the nodules were 2 and 5 cm, respectively. Distant metastases and tumor vascular invasion were observed in 10% and 13% of cases, respectively. A liver transplant was performed in 10% of cases. The mean overall survival was 60 months, with a 1-, 3- and 5-year survival probability of 74%, 40% and 32%, respectively. The independent predictors of a higher risk of death were male gender (P < 0.001), advanced age (P < 0.004), serum alpha-fetoprotein levels > 20 IU/ml (P < 0.03), a high INR (P < 0.016), and tumor vascular invasion (P < 0.004). The independent predictors of a lower risk of death included HCV infection (P < 0.003) and elevated albumin levels (P < 0.009). Conclusion: Male gender, advanced age, elevated alpha-fetoprotein, a high INR and tumor vascular invasion contributed to higher mortality among patients with HCC. On the other hand, patients infected with HCV presented an 80% lower risk of death compared to those with other etiologies.
Descrição
Citação
CARVALHO, Sandra Regina de Almeida. Carcinoma hepatocelular: realidade de um serviço publico especializado. 2015. 67 f. Dissertação (Mestrado em Gastroenterologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.