Search

Background: Hepatocellular carcinoma (HCC) is endemic in parts of Asia and Africa and most patients are not suitable for treatment with a curative approach. Little is known about the cost of palliative care for HCC.Objective: To determine: (i) patient-specific costs of palliative care of HCC; and (ii) individual factors that drive patient-specific costs and to develop a model of cost per case under alternative circumstances.Methods: 204 patients with inoperable HCC were prospectively tracked from first hospitalisation until death for health service utilisation. A societal perspective of cost was taken, including costs of formal and informal services incurred by payers, caregivers and patients. Observational data from a large Hong Kong cancer care programme were used. A regression analysis was performed using formal costs only, with the cost per observed day as the dependent variable.Results: The median survival was 95 days and the mean observation period was 153 days. The mean value per person for formal healthcare cost was 30 983 Hong Kong dollars [$HK] ($US3872, 1998 values). The distribution of cost values were positively skewed. The regression analysis showed that age, days of observation and survival were negatively related to cost per observed day, and the Child-Pugh grading of severity of liver cirrhosis was positively related to cost per observed day. A sensitivity analysis based on the regression equation indicated that nonsurvivorship doubles the cost per case, increased severity as measured by the Child-Pugh Index adds about 50% to the cost, and chemotherapy increases cost 2-fold.Conclusions: The relatively modest average cost per patient with HCC in Hong Kong reflects the short median survival and subsequently the limited use of inpatient care and chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Measurement of alpha-fetoprotein (AFP) is widely used in diagnosing hepatocellular carcinoma (HCC). However, moderately elevated AFP levels are also found in patients with chronic liver diseases. Separated by isoelectric focusing, AFP isoforms appearing as Band + II have been found to be specific for HCC. Recently, the Band + II isoforms have been identified to be monosialylated AFP (msAFP), which has one sialic acid residue fewer than the predominant AFP isoforms associated with liver cirrhosis. The beta-galactoside alpha-2,6-sialyltransferase (ST2,6Gal I) is the key liver enzyme to transfer terminal sialic acid to the carbohydrate side chain of AFP. Methods: To investigate whether decrease of ST2,6Gal I expression and/or enzyme activity is the underlying cause for the formation of msAFP, serum sample, tumour and nontumour samples were collected from 19 HCC patients for the measurement of serum msAFP percentage, tissue ST2,6Gal I activity, and ST2,6Gal I mRNA. Results: Serum msAFP percentage was negatively correlated with absolute ST2,6Gal I activity in the tumour tissue (r = -0.423, P = 0.07) and with the percentage change of enzyme activity (r = -0.540, P < 0.02). Positively correlation between the enzyme activity and the mRNA level of ST2,6Gal I was found in nontumour tissues (r = 0.643, P < 0.01), but not in tumour tissues. Conclusion: These results suggest that decrease of ST6Gal I activity in tumours is a possible cause for the formation of HCC-specific hyposialylated AFP isoforms. In contrast to nontumour tissues, the down-regulation of the ST6Gal I activity in HCC may not be regulated at the transcription level. [ABSTRACT FROM AUTHOR]

Background: Resection of hepatocellular carcinoma is potentially curative, but local recurrence is common. In this prospective randomised trial, we aimed to find out if one dose of postoperative adjuvant intra-arterial iodine-131-labelled lipiodol could reduce the rate of local recurrence and increase disease-free and overall survival.Methods: Patients who underwent curative resection for hepatocellular carcinoma and recovered within 6 weeks were randomly assigned one 1850 MBq dose of 131I-lipiodol or no further treatment (controls). We compared rates of recurrence and disease-free and overall survival (the primary endpoints) between the two groups by intention to treat. We planned an interim analysis when 30 patients (both groups together) had been followed up for a median of 2 years, with the intention of stopping early if the between-group difference in disease-free survival was significant (p=0.029).Findings: Between April, 1992, and August, 1997, we recruited 43 patients: 21 received intra-arterial 131I-lipiodol and 22 received no adjuvant treatment. During a median follow-up of 34.6 (range 14.1-69.7) months, there were six (28.5%) recurrences among the 21 patients in the adjuvant treatment, compared with 13 (59%) in the controls (p=0.04). Median disease-free survival in the treatment and control groups was 57.2 (0.4-69.7) and 13.6 (2.1-68.3) months, respectively (p=0.037). 3-year overall survival in the treatment and control groups was 86.4% and 46.3%, respectively (p=0.039). The interim analysis showed a significant increase in disease-free survival in the treatment group compared with the controls (p=0.01), so we closed the trial early. 131I-lipiodol had no significant toxic effects.Interpretation: In patients with hepatocellular carcinoma, one 1850 MBq dose of intra-arterial 131I-lipiodol given after curative resection significantly decreases the rate of recurrence and increases disease-free and overall survival. [ABSTRACT FROM AUTHOR]