Kerdsuknirun Jitrapa, Vilaichone Virunpat, Vilaichone Ratha-Korn
Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand. Email:
Asian Pac J Cancer Prev. 2018 Nov 29;19(11):3301-3305. doi: 10.31557/APJCP.2018.19.11.3301.
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.
肝细胞癌（HCC）是东盟地区常见的癌症。静脉曲张出血（VB）被认为是肝硬化合并HCC的致命并发症。然而，东盟地区对此的研究报道有限。本研究的目的是评估HCC患者的总体生存率及VB的预测因素。方法：我们对2012年1月至2016年1月期间年龄≥15岁的HCC患者进行了一项回顾性队列研究，并在泰国法政大学医院随访至2016年6月。通过查阅病历的计算机数据库收集临床信息和影像学检查结果。结果：333例患者有完整可获取的信息。其中，27例（8.1%）有VB记录。VB组体重减轻和黄疸的临床表现高于非VB组（40.74%对34.64%，p = 0.525；7.41%对2.29%，p = 0.116），但差异无统计学意义。VB的HCC患者中肝硬化最常见的原因是慢性乙肝感染（55.56%）。多因素分析显示；腹水的存在、Child-Pugh评分>6、静脉曲张的存在是HCC患者发生VB的独立危险因素（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）。有VB的HCC患者1年和2.5年生存率分别为56.6%和28.3%。结论：有腹水、Child-Pugh评分>6和静脉曲张的HCC患者可能是VB的重要预测因素。发生VB对HCC患者的生存率有很大影响。对有风险的HCC患者进行临床怀疑和定期监测VB可改善治疗效果。
