Prognostic Factors and Causes of Mortality in Thai Patients with Hepatocellular Carcinoma: A Retrospective Cohort Study

Background: Hepatocellular carcinoma (HCC) is a complex and heterogeneous disease with prognosis influenced by numerous factors but determinants and causes of mortality in Thai HCC patients remain underrepresented. Objective: To identify prognostic factors and causes of death in Thai HCC patients at a referral hospital. Materials and Methods: A retrospective cohort study was conducted at the Medical Oncology Unit of Sawanpracharak Hospital, Thailand, included patients diagnosed with HCC between October 2018 and September 2022. Diagnoses were confirmed by either pathological examination or characteristic image findings on multiphase computed tomography (CT) or magnetic resonance imaging (MRI). Survival data were analyzed using Kaplan-Meier and log-rank tests, followed by Cox proportional hazards regression for significant variables. Results: Among 398 patients analyzed, 329 (82.66%) died, and the median overall survival (OS) was 4.57 months. No significant OS differences were found between viral and non-viral hepatitis-associated HCC. Independent factors for poorer survival included ECOG 3-4 (HR 1.631, p=0.007), elevated alpha fetoprotein (AFP) levels greater than 400 ng/mL (HR 1.366, p=0.031), elevated alkaline phosphatase (ALP) activity of 172 IU/L or greater (HR 2.201, p<0.001), neutrophil-to-lymphocyte ratio (NLR) of 5 or greater (HR 1.450, p=0.023), platelet-to-lymphocyte ratio (PLR) of 150 to 300 (1.423, p=0.020), Barcelona clinic liver cancer (BCLC) stage C or D (HR 3.589, p=0.001), and worse Child-Pugh (CP) scores (CP-B: HR 1.659, p=0.001; CP-C: HR 2.194, p=0.001). Conclusion: Thai HCC patients demonstrated short survival. Advanced ECOG status, elevated AFP and ALP levels, high NLR and PLR ratios, advanced BCLC stage, and poor CP scores were associated with poor outcomes.