Clinical Outcome and Predictive Factors of Variceal Bleeding in Patients with Hepatocellular Carcinoma in Thailand

Jitrapa Kerdsuknirun,Virunpat Vilaichone,Ratha-Korn Vilaichone

doi:10.31557/apjcp.2018.19.11.3301

Abstract

Objective:Hepatocellular carcinoma (HCC) is common cancer in ASEAN. Variceal bleeding (VB) is considered to be fatal complication of cirrhosis with HCC. However, limited studies were reported in ASEAN. Aim of this study was to evaluate overall survival rate and predictors of VB in HCC patients.Methods:We conducted a retrospective cohort study of HCC patients aged ≥15 years between January 2012-January 2016 and follow up through June 2016 at Thammasat University Hospital, Thailand. Clinical information and radiologic findings were collected from reviewing computer database of medical records.Results:333 patients had completely retrievable information. Of which, 27 patients (8.1%) had documented with VB. Clinical presentations with weight loss and jaundice were higher in VB than non-VB groups (40.74% vs. 34.64%, p=0.525 and 7.41% vs. 2.29%, p=0.116) but the differences were not significant. The most common causes of cirrhosis in HCC patients with VB were chronic HBV infection (55.56%). In multivariate analysis; presence of ascites, Child-Pugh score>6, presence of varices were independent risk factors of having VB in HCC patients (OR=7.59, 95%CI=1.13-50.88, p=0.037; OR=5.07, 95%CI=1.08-23.76, p=0.039; OR=23.51, 95%CI=4.71-117.35, p<0.001, respectively). In HCC patients with VB, 1-year and 2.5-year survival rates were 56.6% and 28.3%.Conclusions:HCC patients with ascites, Child-Pugh score>6 and presence of varices might be important predictive factors of VB. Having VB were greatly impact to the survival rate of HCC patients. Clinical suspicion and regular surveillance of VB in HCC patients at risk could improve treatment outcomes.

Highlights

Hepatocellular carcinoma (HCC) is the sixth most common cancer and leads to major cancer related death worldwide (El-Serag, 2011; Kaneko et al, 2017; Chuncharunee and Siramolpiwat, 2017; Loho et al, 2016; Intaraprasong et al, 2016 )
The overall survival of HCC patients presenting with variceal bleeding was significantly worse than symptomatic HCC patients without Variceal bleeding (VB) with the median survival of 3.5 months vs. 5 months (Lang et al, 2004)
Variceal bleeding is a vital complication of cirrhosis and associated with significant mortality of 10-20% at 6 weeks (Graham and Smith, 1981; De Franchis, 2015)

Summary

Introduction

Hepatocellular carcinoma (HCC) is the sixth most common cancer and leads to major cancer related death worldwide (El-Serag, 2011; Kaneko et al, 2017; Chuncharunee and Siramolpiwat, 2017; Loho et al, 2016; Intaraprasong et al, 2016 ). The incidence of HCC is increasing in several developing countries, including Thailand and its dominant causes were related to hepatitis B virus, hepatitis C virus and alcoholic cirrhosis (Liang et al, 2013; Chunlertrith et al, 2000; Loho et al, 2016; Wiangnon et al, 2012; Wanich et al, 2016). The incidence of HCC patients presenting with variceal bleeding ranging from 1%-15% (Lang et al, 2004). HCC is one of several factors that have been associated with increased mortality for an episode of variceal bleeding (D’Amico and De Franchis, 2003). Successful EVL significantly reduced mortality in HCC patients with VB, the overall survival was still poor in this group of patients (Chen et al, 1995,)

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Conclusion