Clinical Outcome and Predictive Factors of Variceal Bleeding in Patients with Hepatocellular Carcinoma in Thailand
Asian Pacific journal of cancer prevention : APJCP(2018)
摘要
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.
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关键词
Hepatocellular carcinoma,variceal bleeding,Thailand
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