Evidence-based Medicine: Time for a change? - Journal of Medical ...

ORIGINAL ARTICLE
Materials and Methods: The study was
carried out in 132 patients of CLD with or
without HCC attending Medicine OPD in
collaboration with Departments of
Radiotherapy and Radiodiagnosis, Regional
Institute of Medical Sciences, Imphal during
September 2008 to August 2010. It is a cross
sectional study. Patients of known underlying
malignancy, un-cooperative and unwilling
subjects were excluded.
Informed written consent was taken for each
case. Detail clinical examination was carried
out for each case. Routine investigations
including complete haemogram, urine routine
examination, kidney function test, liver function
test, prothrombin time, random blood sugar,
hepatitis B surface antigen (HBsAg),
HBeAntigen and HCV antibody were done.
HBV and HCV were confirmed by PCR at
Roche Lab, Mumbai. Computed Tomography
(CT) or Magnetic resonance Imaging (MRI)
was done when USG report and serum AFP
level are suggestive of HCC. Ultrasound/CT
guided aspiration cytology was done for
confirmation of HCC.
RESULTS AND OBSERVATIONS
A total of 132 CLD were enrolled in the study,
out of which 20 (15.16%) have HCC and 112
(84.84%) were without HCC (p = 0.24). Of the
112 CLD without HCC 83 (74.1%) were males
and 29(25.9%) were females; of the 20
subjects with HCC, 17 (85%) were males and
3(15%) females (p = 0.43) as shown
in Table 1.
Table1.Profile of chronic liver disease
Profile Male Female Total
(N=100) (N=32) (N=132)
CLD without HCC 83(83%) 29 (90.62%) 112 (84.84%)
CLD with HCC 17(17%) 3 (9.38%) 20 (15.16%)
The age-wise distribution of CLD with and
without HCC is shown in table 2 and was
found to be maximum in the age group 45-54
years. The ages of the 20 HCC (15.15%) were
all above 35 years. The maximum cases were
from Imphal west which is also most thickly
populated.
Table 2. Age distribution:
Age Group CLD without HCC CLD with HCC Total CLD
64 yrs 7 (6.25%) 5 (25%) 12
Total 112 (100%) 20 (100%) 132
Of the 132 chronic liver disease subjects,
69(52 presented with abdominal distension,
49 with fever and 43 with jaundice. 21 had
generalised weakness, 12 pain abdomen, 10
upper GI bleeding, 4 hepatic encephalopathy
and 2 with pulmonary tuberculosis. 18 had
palpable hepatomegaly.
The associated risk factors among the 132
CLD were alcoholism (67 cases ie 50.75%),
HCV (61 cases ie 46.21%) and HBV (11 ie
8.33%). Twenty-six of the 67 chronic ALD were
associated with HIV, chronic HCV, chronic
HBV or combination of these. Of the 61 chronic
HCV, 37(60.65%) were HCV mono-infection
and the other 24 (39.35%) chronic HCV were
associated with other risk factors like ALD (7
cases), HIV (13 cases), HBV (3 cases) and
HIV-ALD (1case).
There were 20 cases of HCC (15.15%)
amongst the 132 CLD cases. 9 of 61(14.75%)
Graph showing risk factors of chronic liver
disease and HCC
chronic HCV and 3 of 11 (27.27%) chronic
HBV were found to have HCC. 9 HCV
associated HCC were associated with risk
16 JMS * JMS Vol 25 * Vol * No. 25 3 * No. * September, 1 * June, 2010 2011