Primary Prophylaxis for Variceal Bleeding and the Improved Survival of Patients with Newly Diagnosed Hepatocellular Carcinoma.

Abstract

We evaluated the impact of primary variceal bleeding prophylaxis on long-term outcomes of patients newly diagnosed with hepatocellular carcinoma (HCC). A retrospective cohort of 898 patients newly diagnosed with HCC without a history of variceal bleeding [age 57.4±10.4, males 718 (80.0%)] were analyzed for new onset variceal bleeding during follow-up. Variceal bleeding occurred in 72 patients (8.0%) during follow-up. The presence of portal vein thrombosis [hazard ratio (HR) 3.90; 95% confidence interval (CI) 2.09-7.30; p<0.001] and the presence of the red color sign or ≥grade 2 varices at index endoscopy (HR 7.64; 95% CI 4.56-12.80; p<0.001) were independent risk factors for variceal bleeding. The occurrence of variceal bleeding was an independent risk factor for mortality (HR 1.39; 95% CI 1.06-1.82; p=0.015). The cumulative incidence rate of variceal bleeding at 1year was 2.1, 15.3, and 34.2% for those non-indicated for primary prophylaxis (n=760), indicated for primary prophylaxis and received prophylaxis (n=98), and indicated for primary prophylaxis but did not received prophylaxis (n=40) (p<0.001). Primary prophylaxis for variceal bleeding for indicated patients was associated with a reduced risk of mortality in all patients (HR 0.54; 95% CI 0.33-0.88; p=0.014) and in propensity-matched patients (HR, 0.54; 95% CI 0.31-0.95; p=0.033). Variceal bleeding was independent risk factor for survival of newly diagnosed HCC patients. Screening and providing primary prophylaxis for indicated patients should be considered for patients with HCC.