Unique situation of hepatocellular carcinoma in Egypt: A review of epidemiology and control measures

Table 1 Summary of studies discussing the results of different treatment modalities for hepatocellular carcinoma in Egypt

Treatment modality	Ref.	Design	Sample size	Summary of the most important results
Resection	Senbel et al[134]	Retrospective	84	Median OS was 50 mo
	Zakaria et al[132]	Retrospective	204	Predictors of decreased survival: serum AFP level > 400 ng/mL, TTV > 65.5 cm³, microvascular invasion, postoperative decompensation
	Makhlouf et al[135]	Retrospective	28	Predictors for developing post-resection liver failure: low serum albumin-higher child score
Liver transplant	Kamal et al[144]	Retrospective	60	Overall disease-free survival rates at 1, 3, and 5 yr were 96.6%, 93.5%, and 64.2%; Overall, 1-, 3-, and 5-yr survival rates were 98.3%, 93.5%, and 71.4%. Factors affecting recurrence were the tumor grade, lobar distribution, size of the largest nodule, and the total tumor burden in the explanted liver
	Galal et al[139]	Retrospective	75	AFP may predict HCC recurrence after LDLT (area under the curve = 0.806) at cutoff values of more than 66 ng/mL
MWA	Soliman et al[142]	Prospective	88	MWA reached ablation rates of 100%, 75%, and 87.5% for lesions close to the GB, perivascular lesions, and subcapsular lesions, respectively
Radio frequency	Sharaf-Eldin et al[145]	Retrospective	45	Hepatomegaly, heterogenous liver, and splenomegaly, a sign of portal hypertension, together with tumor factors such as large size, bilobar affliction, and lesions near the liver capsule, showed a significant association with tumor recurrence
	Nouh et al[143]	Prospective	60	Combined techniques (RFA and percutaneous ethanol injection) give the best results for management of HCCs in comparison with individual techniques
TACE	Farouk et al[154]	Retrospective	27	Successful TACE for down-staging of HCC can be achieved in the majority of carefully selected patients and is associated with excellent post transplantation outcome
	Fouad et al[155]	Prospective	99	Improved quality of life after three months of TACE
TARE	Hamed et al[162]	Prospective	20	The complete response, partial response, stable disease and disease progression rates for the study sample after 3 mo using the conventional RECIST criteria was 0%, 55%, 30% and 10%, while after 6 mo it became 0, 50%, 20% and 25% respectively
	Hetta et al[163]	Prospective	40	The overall response (complete or partial response) was exhibited by 9% of patients, stable disease exhibited by 80% of patients, progressive disease seen in 11% of patients after one month of TARE
	El Fouly et al[164]	Prospective	86	The median OS (TACE: 18 mo vs TARE Y-90: 16.4 mo) and the median TTP (TACE: 6.8 mo vs TARE Y-90: 13.3 mo) were not statistically different between TACE and TARE group
Systemic therapy	Nada et al[170]	Retrospective	130	The median overall survival of patients with HCC treated with sorafenib was 5 mo (CI: 4.166-5.834), and progression free survival was 4 mo (CI: 3.479-4.521)
	El Baghdady et al[172]	Prospective	55	The one-year OS was 0.0% vs 75.5% (P = 0.008) in control and sorafenib respectively. Median PFS was 5 mo vs 12 mo in control group and sorafenib respectively (P = 0.008). Sorafenib treatment showed a better outcome OS, PFS and QOL as compared to no-treatment in Egyptian patients with advanced Hepatocellular Carcinoma

HCC: Hepatocellular carcinoma; LDLT: Living donor liver transplantation; MWA: Microwave; OS: Overall survival; RFA: Radiofrequency; TACE: Trans arterial chemoembolization; TARE: Trans arterial radioembolization; RECIST: Response Evaluation Criteria in Solid Tumors; CI: Confidence interval; PFS: Progression-free survival; QOL: Quality of life; AFP: Alpha fetoprotein; TTV: Total tumor volume; TTP: Time to progression.