Li Qi, Liu Ruifeng, Zhou Shenghui, Lyu Lingna, Fan Chunlei, Ding Huiguo
Department of Gastroenterology and Hepatology, Beijing You'an Hospital Affiliated with Capital Medical University, Beijing, P.R. China.
Department of Cardiology, Beijing Friendship Hospital Affiliated with Capital Medical University, Beijing, P.R. China.
Ther Adv Chronic Dis. 2025 Jul 31;16:20406223251356824. doi: 10.1177/20406223251356824. eCollection 2025.
Acute esophagogastric variceal bleeding (AEGVB) is a common complication of liver cirrhosis and hepatocellular carcinoma (HCC). It is unclear if older patients with cirrhotic HCC benefit from endoscopic treatment as secondary prophylaxis for AEGVB in short term.
We aim to investigate if endoscopic treatment as secondary prophylaxis for AEGVB reduces short-term mortality in older patients with cirrhotic HCC.
We retrospectively enrolled 138 consecutive patients over 60 years old with cirrhotic HCC and AEGVB from April 1, 2021 through December 31, 2022 in Emergency Room, Beijing You'an Hospital, Capital Medical University.
A 1:1 propensity score matching (PSM) analysis was performed to adjust for confounding factors such as age, gender, Child-Pugh score in our statistical findings. Logistic regression and Cox regression analyses were used to investigate whether there was a significant negative association between endoscopic treatment and short-term mortality for AEGVB in older patients with cirrhotic HCC. Kaplan-Meier methodology was employed to compare overall survival over 6 weeks between the endoscopic treatment group and non-endoscopic treatment group.
In older patients with cirrhotic HCC and AEGVB, in-hospital mortality and 6-week mortality were significantly lower in the endoscopic treatment group compared to the non-endoscopic treatment group before PSM (5.33% vs 26.98%, = 0.001 for in-hospital mortality; 12.00% vs 44.44%; < 0.001 for 6-week mortality). These results remained consistent after PSM (4.76% vs 26.98%, = 0.002 for in-hospital mortality; 9.52% vs 44.44%; < 0.001 for 6-week mortality). Both logistic regression and Cox regression analyses found that endoscopic treatment contributed to reduced short-term mortality for AEGVB in older patients with cirrhotic HCC. Kaplan-Meier survival curves indicated that older patients undergoing endoscopic treatment had a higher short-term survival rate than those who didn't receive endoscopic treatment in our cohort. However, there was no significant difference in short-term survival between patients receiving endoscopic variceal ligation and those treated with endoscopic injection sclerotherapy.
Secondary prophylaxis of endoscopic treatment helps to reduce 6-week mortality for AEGVB in older patients with cirrhotic HCC. Therefore, endoscopic treatment is suggested to be employed as secondary prophylaxis in this special population in clinical practice.
急性食管胃静脉曲张出血（AEGVB）是肝硬化和肝细胞癌（HCC）的常见并发症。目前尚不清楚老年肝硬化HCC患者短期内接受内镜治疗作为AEGVB的二级预防是否有益。
我们旨在研究内镜治疗作为AEGVB的二级预防是否能降低老年肝硬化HCC患者的短期死亡率。
我们回顾性纳入了2021年4月1日至2022年12月31日期间首都医科大学附属北京佑安医院急诊科连续收治的138例60岁以上的肝硬化HCC合并AEGVB患者。
进行1:1倾向评分匹配（PSM）分析，以调整年龄、性别、Child-Pugh评分等混杂因素。采用逻辑回归和Cox回归分析来研究内镜治疗与老年肝硬化HCC患者AEGVB短期死亡率之间是否存在显著的负相关。采用Kaplan-Meier方法比较内镜治疗组和非内镜治疗组6周内的总生存率。
在老年肝硬化HCC合并AEGVB患者中，PSM前内镜治疗组的住院死亡率和6周死亡率显著低于非内镜治疗组（住院死亡率：5.33% vs 26.98%，P = 0.001；6周死亡率：12.00% vs 44.44%，P < 0.001）。PSM后结果仍保持一致（住院死亡率：4.76% vs 26.98%，P = 0.002；6周死亡率：9.52% vs 44.44%，P < 0.001）。逻辑回归和Cox回归分析均发现内镜治疗有助于降低老年肝硬化HCC患者AEGVB的短期死亡率。Kaplan-Meier生存曲线表明，在我们的队列中，接受内镜治疗的老年患者短期生存率高于未接受内镜治疗的患者。然而，接受内镜下静脉曲张结扎术的患者与接受内镜注射硬化剂治疗的患者短期生存率无显著差异。
内镜治疗二级预防有助于降低老年肝硬化HCC患者AEGVB的6周死亡率。因此，建议在临床实践中对这一特殊人群采用内镜治疗作为二级预防措施。
