1. HEPATOCELLULAR CARCINOMA (HCC) at
Liver Tumor Department – Cho Ray Hospital
NGUYEN DINH SONG HUY, MD Vice Director of Cancer Center Head of Liver Tumor Department Cho Ray Hospital

2. 2016 : HCC is the 5th (male) and the 9th (female)
most common cancer worldwide
Nam Nữ
Cancer incidence worldwide (Globocan 2016, IARC, WHO)

3. GLOBOCAN 2012 (IARC) Section of Cancer Surveillance
HCC in Vietnam
GLOBOCAN 2012 (IARC) Section of Cancer Surveillance

4. Study purposes Number of new HCC patients per years
Number of new HCC patients already in far advanced stage per years
Relationship with hepatitis virus infection
Value of AFP in diagnosis of HCC

5. Materials & Methods Inclusive criteria : All adult patients, ≥ 15 yo.
Diagnosed of HCC
at Liver Tumor Department
Cho Ray hospital
according to Vietnam Guideline for HCC 2012
Methods : Retro-observational study

6. 6 * Associated diseases with high risk in operation Child B
Easy to approach
Associated diseases *
Child C
Child A,B
Any size
PV thrombosis, N1, M1
PST 1-2
Child A/B
PST >2
End stage
≤ 3 tumor, ≤ 3cm
1 tumor ≤ 5cm
Resection
RFA
Transplantation
TACE
Sorafenib
Multifocal tumors
PST 0-2 Child A/B
PST 0-1
Resectable
No metastasis, no PV hypertension
Unresectable
HEPATOCELLULAR CARCINOMA
Liver biopsy
Increasing AFP < 400 ng/ml
HBV or HCV infection
(-)
(+)
2nd Liver biopsy
Follow every 2 months
Characteristic CT scan / MRI
Liver tumor
Characteristic or Non-characteristic CT scan / MRI or non-increase AFP
AFP ≥ 400 ng/ml
Best Supportive Care 6

7. RESULTS

8. SEX
DISTRIBUTION

9. Number of new HCC patients per year Sex distribution
 Female (18.24%)
Total patients
 Male (81.76%)

10. Comments Number of HCC patients coming to Liver Tumor Department
Cho Ray Hospital increases by year
 necessary surveillance of HCC on high risk group
by US + AFP every 6 months (according to APASL),
and using biomarkers AFP-L3 and PIVKA II (DCP)
Male / Female ratio : 4.48 / 1

11. AGE
DISTRIBUTION

12. Number of new HCC patients per year Age distribution
15-20
>20-30
>30-40
>40-50
>50-60
>60-70
>70
0.29%
1.59%
6.61%
17.64%
29.92%
24.86%
19.08%

13. Number of new HCC patients per year Age distribution
15-20
>20-30
>30-40
>40-50
>50-60
>60-70
>70
2010
2011
2012
2013
2014
2015
2016

14. Comments 91.51% HCC patients > 40 yo.
Most patients are in the age of (29.92%)
Causes
Natural history from hepatitis virus infection to HCC # 15 years
HBV vaccination just started # 15 years

15. GEOGRAPHIC
DISTRIBUTION

16. Geographic distribution
New HCC patients
Geographic distribution

17. New HCC patients
Region distribution

18. New HCC patients - Region distribution
Mekong river Delta
2010
2011
2012
2013
2014
2015
2016
South East
Middle South
HCMC
Highland
Other

19. POSSIBILITY
OF TREATMENT

20. Number of new HCC patients in far advanced stage
 Female pts (13.60%)
 Male pts (86.40%)
9827 / patients (40.79%)

21. Number of new HCC patients in far advanced stage / New HCC patients
40.59%
43.68%
40.51%
37.64%
40.78%
40.74%
41.68%

22. Number of new HCC patients in far advanced stage Sex distribution
 Female (13.60%)
Total patients
 Male (86.40%)

23. Number of new HCC patients in far advanced stage Age distribution
15-20
>20-30
>30-40
>40-50
>50-60
>60-70
>70
0.30%
1.67%
8.06%
21.15%
31.03%
21.69%
16.12%

24. Number of new HCC patients in far advanced stage Age distribution
15-20
>20-30
>30-40
>40-50
>50-60
>60-70
>70
2010
2011
2012
2013
2014
2015
2016

25. Number of new HCC patients Age distribution
15-20
>20-30
>30-40
>40-50
>50-60
>60-70
>70
2010
2011
2012
2013
2014
2015
2016
Number of new HCC patients in far advanced stage Age distribution

26. Comments 40.79% new HCC patients are already in far advanced stage
89.98% of those patients ≥ 40 yo., mostly > yo.
Causes
HCC usually progresses in silence
HCC usullaly do not has clinical symptoms
Surveillance on high risk group is limited
Limited consciousness of people for health check
Low effect of hepatitis virus treatment

27. HEPATITIS VIRUS INFECTION
RELATIONSHIP WITH
HEPATITIS VIRUS INFECTION

28. Relationship HCC – Hepatitis virus infection (All new HCC patients)
Liver Tumor Dept – Cho Ray hospital :
new HCC patients
9827 (40.79%) new HCC patients in far advanced stage
24091 new HCC patients :
21584 patients (89.59%) were checked of HBsAg & AntiHCV :
HBV % HBV & HCV 2.68 %
HCV % No infection 8.97 %
 patients (91.03%) related to hepatitis virus infection
9827 new HCC patients in far advanced stage :
8595 patients (87.46%) were checked of HBsAg & AntiHCV :
HBV % HBV & HCV 2.20 %
HV % No infection %
 patients (90.65%) related to hepatitis virus infection

29. Relationship HCC – Hepatitis virus infection
2010
2011
2012
2013
2014
2015
2016
HBV infection
HCV infection
HBV & HCV infection
No infection
Not recorded

30. 9827 / 24091 patients Relationship HCC – Hepatitis virus infection
(Far advanced HCC patients group)
2010
2011
2012
2013
2014
2015
2016
HBV infection
HCV infection
HBV & HCV infection
No infection
Not recorded
9827 / patients

31. Comments Causes of HCC in Vietnam
close relationship with hepatitis virus infection
most popular is HBV infection
HBV / HCV infection ratio is
2.39 / 1 (all new patients)
3.48 / 1 (far advanced HCC patients group)
 any difference in the development of HCC ?
HCV infection rate is increasing
No infection rate is increasing

32. New HCC patients - Region distribution
Relationship HCC – Hepatitis virus infection
HBV infection
HCV infection
HBV & HCV infection
No infection
Not recorded
New HCC patients per year transferred from Regions
New HCC patients per year
already in far advanced stage
transferred from Regions

33. DIAGNOSTIC ROLE OF AFP

34. AFP in new HCC patients < 20 ng/ml 23.21% > 20-100 ng/ml 14.61%
Not recorded %

35. Comments AFP has limited value in diagnosis of HCC
New biomarkers are useful for surveillance, diagnosis and follow up of HCC
AFP-L3 and PIVKA II (DCP)
Used first time in Vietnam at Cho Ray hospital
Hope to improve HCC surveillance in Vietnam

36. CONCLUSION

37. High incidence of HCC in Vietnam
Close relationship with hepatitis virus infection
Most patients come to high level hospitals  overload
Not so much attention on HCC surveillance from both medical staff and high risk people sites
Management of viral hepatitis patients is not so good
Relative low result of viral hepatitis treatment

38. THANK YOU FOR
YOUR KIND ATTENTION