Sato Masaya, Tateishi Ryosuke, Yasunaga Hideo, Matsui Hiroki, Horiguchi Hiromasa, Fushimi Kiyohide, Koike Kazuhiko
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
J Gastroenterol Hepatol. 2017 Nov;32(11):1873-1878. doi: 10.1111/jgh.13780.
Because of the rarity of invasive treatment for hepatocellular carcinoma (HCC) in patients on hemodialysis (HD) for end-stage renal disease (ESRD), the risks associated with radiofrequency ablation (RFA) in such patients remain uncertain. We used a nationwide database to investigate in-hospital mortality and hemorrhagic complications following RFA in patients on HD for ESRD.
Using the Japanese Diagnosis Procedure Combination database, we enrolled patients on HD for ESRD who underwent RFA for HCC. For each patient, we randomly selected up to four non-dialyzed patients using a matched-pair sampling method based on patient age, sex, treatment hospital, and treatment year. In-hospital mortality and hemorrhagic complications were compared between dialyzed and non-dialyzed patients following RFA.
We compared matched-pair samples of 437 dialyzed and 1345 non-dialyzed patients. In patients on HD for ESRD, mortality was significantly lower in those aged ≤70 years than in older patients (P = 0.02). In-hospital mortality was significantly higher in dialyzed ESRD patients than in non-dialyzed patients (1.1% vs 0.15%, respectively; odds ratio = 7.77, P < 0.001). Hemorrhagic complications differed significantly between dialyzed ESRD patients and non-dialyzed patients (3.4% vs 0.87%, respectively; odds ratio = 4.75, P < 0.001).
In-hospital mortality following RFA was higher in dialyzed ESRD patients than in non-dialyzed patients. The indications for RFA in dialysis-dependent patients should be considered carefully. Patient age may be a useful indicator when considering RFA for HCC in patients on HD for ESRD.
由于终末期肾病（ESRD）接受血液透析（HD）的肝细胞癌（HCC）患者进行侵入性治疗的情况罕见，此类患者接受射频消融（RFA）的相关风险仍不确定。我们使用全国性数据库调查了ESRD接受HD的患者在RFA后的院内死亡率和出血并发症。
利用日本诊断程序组合数据库，我们纳入了因HCC接受RFA的ESRD接受HD的患者。对于每位患者，我们基于患者年龄、性别、治疗医院和治疗年份，采用配对抽样方法随机选择多达4名未透析患者。比较透析患者和未透析患者在RFA后的院内死亡率和出血并发症。
我们比较了437名透析患者和1345名未透析患者的配对样本。在ESRD接受HD的患者中，年龄≤70岁者的死亡率显著低于老年患者（P = 0.02）。透析的ESRD患者的院内死亡率显著高于未透析患者（分别为1.1%和0.15%；优势比 = 7.77，P < 0.001）。透析的ESRD患者和未透析患者的出血并发症有显著差异（分别为3.4%和0.87%；优势比 = 4.75，P < 0.001）。
透析的ESRD患者RFA后的院内死亡率高于未透析患者。应谨慎考虑依赖透析患者的RFA适应症。在考虑对ESRD接受HD的HCC患者进行RFA时，患者年龄可能是一个有用的指标。
