Diffuse and nodular type hepatoma: a prospective, comparative study

Abstract

INTRODUCTIONS: Incidence of hepatocellular carcinoma (HCC) is increasing. Diffuse type HCC is rare and data on such tumors are limited. METHODS: All patients referred to North Colombo Liver Unit with HCC from September 2011 to February 2014 were included. Data were collected prespectively from 206 patients. Tumors with diffuse margin in imaging were categorized as diffuse HCC (n-41, 21%). Baseline parameters, treatment options and survival were compared with nodulartype'HCC. RESULTS: 87.8% of patients in the diffuse HCC group were males compared to 89.54 % in nodular HCC group. The median age in the two groups were similar (nodular 62.13 years (range 12-88), diffuse 63.58 years (range 47-76)). Heavy alcohol use was commoner in the diffuse HCC group (68.9% vs. 41.7 %, p=0.002). 90.2% with diffuse HCC had cirrhosis compared to 79.1% with nodular HCC (p<0.05). Aspartate transaminase (AST), alanine transarninase (ALT), INR, total bilirubin, platelet count, MELD score were similar in two groups. Alfa Feto Protein (AFP) value was significantly higher in diffuse HCC group (p<0.001). 80.5% patients with diffuse type HCC had typical enhancement pattern compared to 84.4% with nodular type. Diffuse HCC group had higher incidence of major vascular invasion (78% vs. 23.5%, p<0.001). 76.9% of diffuse HCC group had only palliative care compared to 28.4% in nodular type (p<0.001). Median survival in diffuse group was 2.0 months compared to 8.0 months in nodular type. CONCLUSIONS: 21% of HCC are diffuse type. Alcohol intake was commoner in this group. Diffuse HCC had poorer prognosis with high AFP level and vascular invasion. Majority had advanced disease at presentation.