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Dr Muhammad Abdullah, Dr Ehtisham Ilyas Khan, Dr. Shagufta Khan


Aim: To evaluate the patient’s various socio-demographic and clinical factors related to advanced HCC. Place and Duration: In the Gastroenterology department of Jinnah Hospital Lahore for one-year duration from March 2019 to March 2020. Methods: The study was conducted on the basis of a retrospective assessment of various socio-demographic data (age, gender, place of residence, socioeconomic status and habits), clinical presentation, basic risk factors (CHC, CHB and unspecified), child classification and APRI assessment of liver fibrosis of all 690 HCC patients registered in the HCC database. All patients were divided into two groups: Group 1, which included 250 patients with early HCC, their age with mean ± standard deviation (SD) is 54.8 ± 12.795, and the male / female ratio was 155/95. Group 2: It consisted of 440 patients with moderate to advanced HCC, their age with mean ± SD of 57.05 ± 13.366, and male to female ratio 299/141. HCC diagnosis is based on four-phase computed tomography (MDCT) and / or MRI with dynamic contrast. Results: Our results revealed that advanced patients with HCC in group 2 had a much higher age distribution, presented much more in patients from rural areas and also presented much more in poor socioeconomic conditions than patients with early HCC in group 1 (P 0 values, respectively) , 0309, 0.0455 and 0.0107). In patients with advanced HCC from group 2, significant importance of liver fibrosis with a higher degree according to APRI and Child B or C classification was significantly more important than in early patients with group 1 HCC (P values <0.0001 for both). Male sex, smoking, BMI and DM are not significantly associated with advanced patients with group 2 HCC (p values 0.0309, 0.0628, 0.6168 and 0.0969). Clinical presentations of early HCC patients in group 1 were accidentally discovered asymptomatically, much more than presentations of advanced HCC patients in group 2 (p value <0.0001). CHB and CHC were the largest risk factors for both early and advanced HCC (p-value <0.0033). Conclusion: Advanced HCCs are significantly associated with poor socioeconomic status, especially in rural areas, which can lead to delayed diagnosis until HCC become more advanced and symptomatic, while advanced HCCs are associated with high liver fibrosis and more advanced liver disease. Based on these conclusions, we should recommend regular screening programs for the early detection of HCC, especially in rural areas with poor socioeconomic status, especially in elderly patients with high liver fibrosis and grade B or C in a child


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