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Outcome of hepatocellular carcinoma presenting with variceal bleeding

A report in November's American Journal of Gastroenterology states that HCC patients who present with variceal bleeding have a significantly worse survival outcome than the general HCC patients, but transarterial chemoembolization may offer some survival benefit.

News image

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Variceal bleeding is an important manifestation of hepatocellular carcinoma (HCC).

However, little has been documented in the literature regarding the outcomes of HCC patients presenting with variceal bleeding.

Researchers from Hong Kong, in China designed a study to evaluate the clinical characteristics, management, and outcomes of this specific group of patients.

The research team, led by Dr Ronnie Poon, undertook a retrospective analysis of a prospectively collected database comprising 2,928 HCC patients managed from January 1989 to December 2002.

In total, the team identified 78 patients who had presented with variceal bleeding.

The researchers then compared their clinical outcomes were to those patients who did not present with variceal bleeding.

The team performed multivariate analysis to identify prognostic factors for their survival.

In the variceal bleeding group, treatment with transarterial chemoembolization was the only independent prognostic factor for survival
American Journal of Gastroenterology

The researchers found that HCC patients who presented with variceal bleeding had more severe cirrhosis than those who did not, with a significantly higher serum bilirubin level, lower albumin level, lower platelet count, and longer prothrombin time.

In addition, the research group noted that they had significantly smaller HCCs but more frequent portal vein thrombosis.

There was a significant difference in the overall survival between HCC patients who presented with variceal bleeding and those who did not.

The investigators found, by multivariate analysis, that in the variceal bleeding group, treatment with transarterial chemoembolization was the only significant independent prognostic factor for survival.

Dr Poon concluded, "HCC patients who presented with variceal bleeding can be expected to have a significantly worse survival outcome than the general HCC patients."

"However, transarterial chemoembolization may offer some survival benefit to a selected group of HCC patients presenting with variceal bleeding."

American Journal of Gastroenterology; 2004: November issue: OnlineEarly
19 November 2004

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