International Journal of Research in Oncology
Open AccessPrioritizing Hepatocellular Carcinoma Management Strategies and Their Impact on the Outcome of Treatment in Egypt: A Single-Centre Real-Life Retrospective Cohort Study
Authors: Reda Elwakil, Eman MF Barakat, Mahmoud El-Meteini, Ahmed El Dorry, Heba Mohamed Abdella, Iman Fawzy Montasser, Heba Ismail Saad Ali, Osama Ashraf Ahmed, Mohamed Salaheldin, Mohamed Shaker Ghazy, Mohamed ElGharib AbouElmaaty, Mohamed Sobhy Hassan, Karim A, Abd Eltawab, Allam Elsayed Allam, Mohamed Bahaa, Khaled M Abd Elaziz, Manar Mohamed Ellaban, Dina Fathy, Safa Ragab Askar, Mostafa Abd Alfattah Shamkh, Yasser Arafat Abdelrazek, Abdelaziz Ahmed Abdelaziz, Enas mohamed Soliman, Nevien Fouad El fouly, Ahmed A Sleem, Nourhan Mohamed Abdallah, Omar Elwakil, Mohamed Kamal Shaker.
Abstract
Background: Hepatocellular carcinoma (HCC) is a significant health concern worldwide, with low- and middle-income countries bearing the brunt of its high incidence and mortality. In such settings, the priority of curative, locoregional, and systemic therapies is heavily reliant on multidisciplinary team (MDT)-guided decision-making.
From August 2018 to August 2025, a retrospective cohort study was conducted on adult patients with confirmed HCC who were managed through specialized MDT at Ain Shams University Hospitals in Egypt. Patients were categorized as either interventional radiology, surgical, systemic therapy, or best supportive care pathways according to MDT recommendations. The results incorporated overall survival (OS), disease free survival (DFS), and radiologic response estimated using modified Response Evaluation Criteria in Solid Tumors (mRECIST).
Out of the 686 eligible patients, 155 received interventional radiology treatment, while 156 received surgical therapy, 181 received systemic therapy, and 200 received best supportive care. After radiofrequency ablation, the mean OS in interventional radiology was 26.4 months, while the average OS was 31.7 months after transarterial chemoembolization, with no significant difference between modalities. The most successful long-term outcomes were achieved through surgical management, with liver transplantation achieving near international standards for 5-year OS, despite the need to depend on living donors. Systemic therapy did not improve outcomes, with the median OS of about 5 months, a result of advanced disease stage (hepatic decompensation), portal vein invasion, and restricted access to immunotherapy.
The allocation of resources to HCC treatment through MDT-guided prioritization allows for a rational allocation and results in comparable outcomes, despite resource constraints. To improve outcomes in low-resource settings, it is imperative to incorporate tumor biology into the selection criteria and expand early detection and access to modern systemic therapies.
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