Impact of acute decompensation on the prognosis of patients with hepatocellular carcinoma.

Takayuki Kondo,Masayuki Ohtsuka,Hiroaki Kanzaki,Soichiro Kiyono,Tetsuhiro Chiba,Tomoko Saito,Naoya Kato,Kazufumi Kobayashi,Shingo Nakamoto,Satoshi Kuboki,Makoto Arai,Masato Nakamura,Yoshihiko Ooka,Keisuke Koroki,Jun Kato,Naoya Kanogawa,Sadahisa Ogasawara,Pavel Strnad

doi:10.1371/journal.pone.0261619

Takayuki Kondo, Masayuki Ohtsuka + Show 16 more

Open Access

https://doi.org/10.1371/journal.pone.0261619

Copy DOI

Journal: PloS one	Publication Date: Jan 27, 2022
Citations: 6	License type: CC BY 4.0

Affiliation: Chiba University, Chiba University Hospital

Abstract

Organ failure in patients with acute decompensation (AD) is a defining characteristic of acute-on-chronic liver failure (ACLF). However, the clinical features of AD during the long-term clinical course of hepatocellular carcinoma (HCC) are still poorly understood. This study aimed to clarify features and impact of AD/ACLF on the prognosis of patients after treatment for HCC. This retrospective study enrolled 556 consecutive patients who were initially diagnosed with HCC, and analyses were conducted taking into account HCC treatment type, HCC stage, and presence or absence of cirrhosis. During follow-up, 299 patients with AD were hospitalized. AD occurrence is closely related to prognosis, regardless of the presence or absence of cirrhosis and HCC stage, and early-onset AD (within 90 days after HCC treatment) has negative impact on prognosis. In the intermediate-advanced-stage group, surgical resection had a positive impact on AD incidence post-treatment. After systemic therapy for HCC, renal impairment was the predictive factors for AD development. The 28/90-day mortality rate was higher among 41 cases (13.7%) with AD who exhibited ACLF as compared with cases without ACLF. AD without cirrhosis had similar ACLF incidence and short-term mortality, compared to AD with cirrhosis. The prognostic model using a decision-tree-based approach, which includes ACLF, bilirubin level, HCC progression, and MELD score is useful for predicting 90- or 28-day mortality after AD diagnosis. Careful management of patients with HCC who are hospitalized with AD is necessary, considering ACLF, HCC progression, and liver function.

Highlights

Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related death worldwide.1 Management of HCC should be based on proper assessment of disease severity, treatment, and surveillance [1,2,3]
acute decompensation (AD) occurrence is closely related to prognosis, regardless of the presence or absence of cirrhosis and HCC stage, and earlyonset AD has negative impact on prognosis
After systemic therapy for HCC, renal impairment was the predictive factors for AD development

Summary

Introduction

Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related death worldwide. Management of HCC should be based on proper assessment of disease severity, treatment, and surveillance [1,2,3]. Management of HCC should be based on proper assessment of disease severity, treatment, and surveillance [1,2,3]. Over the past few decades, despite the improvement of disease management, the outcomes of HCC remain unsatisfactory [1,4]. In patients with HCC, the prevalence of concomitant liver cirrhosis is greater than 80%, and the liver functional reserve is one of the critical factors affecting their prognosis [1,2,3]. The occurrence of hepatic and extrahepatic organ failure in patients with AD is indicative of acute-on-chronic liver failure (ACLF). ACLF occurs in approximately 30% of patients with acute AD and is associated with a 28-day mortality rate of roughly 30% [9,10,11]

Objectives

Methods

Results

Conclusion