Hsu Chia-Yang, Lee Yun-Hsuan, Huang Yi-Hsiang, Hsia Cheng-Yuan, Su Chien-Wei, Lin Han-Chieh, Lee Rheun-Chuan, Chiou Yi-You, Lee Fa-Yauh, Huo Teh-Ia, Lee Shou-Dong
Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan.
Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.
Hepatol Int. 2013 Mar;7(1):188-98. doi: 10.1007/s12072-011-9338-z. Epub 2012 Jan 8.
Ascites may develop in patients with hepatocellular carcinoma (HCC) with coexisting liver cirrhosis. Few studies had specifically evaluated the role of ascites in HCC. This study investigated its prevalence, associated factors, prognostic impact, and staging strategy in a large HCC patient cohort.
A total of 2,203 HCC patients were analyzed. The grading of ascites was according to the European Association for the Study of Liver. The prognostic ability of the Cancer of the liver Italian Program (CLIP), Barcelona Clinic Liver Cancer, Japan Integrated Scoring system, and Taipei Integrated Scoring system in HCC patients with ascites was compared using the Akaike information criterion (AIC).
Ascites was present in 498 (23%) patients at diagnosis. Grades 1, 2, and 3 ascites were found in 13, 5, and 5% of the patients, respectively. The severity of ascites significantly correlated with hyperbilirubinemia, hypoalbuminemia, hyponatremia, prothrombin time (PT) prolongation, and renal insufficiency (all p < 0.001). Large tumor burden and more frequent vascular invasion were often observed in patients with more severe ascites (both p < 0.001). In the Cox proportional hazard model, ascites was identified as an independent prognostic predictor with 80-94% increased risk of mortality (p < 0.001). Among HCC patients with ascites, the CLIP system had the lowest AIC value.
Ascites is often seen in HCC patients and is associated with both tumoral and cirrhosis factors and decreased long-term survival. The CLIP staging system is a more feasible prognostic model for HCC patients with ascites. The optimal treatment strategy for these patients remains to be investigated.
肝细胞癌（HCC）合并肝硬化患者可能会出现腹水。很少有研究专门评估腹水在HCC中的作用。本研究在一个大型HCC患者队列中调查了腹水的患病率、相关因素、预后影响及分期策略。
共分析了2203例HCC患者。腹水分级依据欧洲肝脏研究协会标准。使用赤池信息准则（AIC）比较了意大利肝癌项目（CLIP）、巴塞罗那临床肝癌分期系统、日本综合评分系统和台北综合评分系统对HCC腹水患者的预后评估能力。
498例（23%）患者在诊断时存在腹水。1级、2级和3级腹水分别见于13%、5%和5%的患者。腹水严重程度与高胆红素血症、低白蛋白血症、低钠血症、凝血酶原时间（PT）延长及肾功能不全显著相关（均p<0.001）。腹水较严重的患者通常肿瘤负荷较大且血管侵犯更频繁（均p<0.001）。在Cox比例风险模型中，腹水被确定为独立的预后预测因素，死亡风险增加80 - 94%（p<0.001）。在HCC腹水患者中，CLIP系统的AIC值最低。
腹水在HCC患者中常见，与肿瘤及肝硬化因素相关且会降低长期生存率。CLIP分期系统是HCC腹水患者更可行的预后模型。这些患者的最佳治疗策略仍有待研究。
