Original Contribution
The American Journal of Gastroenterology (2004) 99, 2158–2165; doi:10.1111/j.1572-0241.2004.40336.x
Outcomes of Patients with Hepatocellular Carcinoma Presenting with Variceal Bleeding
Brian H Lang MBBS, MRCS1, Ronnie T Poon MS, FRCS, FACS1, Sheung T Fan MS, MD, PhD, FRCS, FACS1 and John Wong PhD, FRACS, FACS1
1Centre for the Study of Liver Disease and Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China
Correspondence: Ronnie T Poon, MS, FRCS, FACS, The University of Hong Kong, Department of Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
Received 29 April 2004; Revised 0000; Accepted 25 May 2004.
Abstract
OBJECTIVE
Variceal bleeding is an important manifestation of hepatocellular carcinoma (HCC). However, little has been documented in the literature regarding the outcomes of HCC patients presenting with variceal bleeding. This study evaluated the clinical characteristics, management, and outcomes of this specific group of patients.
METHODS
A retrospective analysis of a prospectively collected database comprising 2,928 HCC patients managed from January 1989 to December 2002 identified 78 patients who had presented with variceal bleeding. Their clinical outcomes were compared to those patients who did not present with variceal bleeding, and a multivariate analysis was performed to identify prognostic factors for their survival.
RESULTS
HCC patients who presented with variceal bleeding had more severe cirrhosis than those who did not, with a significantly higher serum bilirubin level, lower albumin level, lower platelet count, and longer prothrombin time. They had significantly smaller HCCs but more frequent portal vein thrombosis. There was a significant difference in the overall survival between HCC patients who presented with variceal bleeding and those who did not (median 3.5 months vs 7.5 months, p < 0.001). In the variceal bleeding group, by multivariate analysis, treatment with transarterial chemoembolization was the only significant independent prognostic factor for survival (odds ratio 17.16, 95% CI: 2.81–104.91, p= 0.002).
CONCLUSIONS
HCC patients who presented with variceal bleeding can be expected to have a significantly worse survival outcome than the general HCC patients. However, transarterial chemoembolization may offer some survival benefit to a selected group of HCC patients presenting with variceal bleeding.
