Premium
Rebleeding prophylaxis improves outcomes in patients with hepatocellular carcinoma. A multicenter case‐control study
Author(s) -
Ripoll Cristina,
Genescà Joan,
Araujo Isis K.,
Graupera Isabel,
Augustin Salvador,
Tejedor Marta,
Cirera Isabel,
Aracil Carles,
Sala Margarita,
HernandezGuerra Manuel,
Llop Elba,
Escorsell Angels,
Catalina Maria Vega,
Cañete Nuria,
Albillos Agustin,
Villanueva Càndid,
Abraldes Juan G.,
Bañares Rafael,
Bosch Jaime
Publication year - 2013
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.26629
Subject(s) - medicine , hepatocellular carcinoma , gastroenterology , portal vein thrombosis , liver transplantation , carcinoma , hepatology , surgery , thrombosis , transplantation
Outcome of variceal bleeding (VB) in patients with hepatocellular carcinoma (HCC) is unknown. We compared outcomes after VB in patients with and without HCC. All patients with HCC and esophageal VB admitted between 2007 and 2010 were included. Follow‐up was prolonged until death, transplantation, or June 2011. For each patient with HCC, a patient without HCC matched by age and Child‐Pugh class was selected. A total of 292 patients were included, 146 with HCC (Barcelona Classification of Liver Cancer class 0‐3 patients, A [in 25], B [in 29], C [in 45], and D [in 41]) and 146 without HCC. No differences were observed regarding previous use of prophylaxis, clinical presentation, endoscopic findings, and initial endoscopic treatment. Five‐day failure was similar (25% in HCC versus 18% in non‐HCC; P = 0.257). HCC patients had greater 6‐week rebleeding rate (16 versus 7%, respectively; P = 0.025) and 6‐week mortality (30% versus 15%; P = 0.003). Fewer patients with HCC received secondary prophylaxis after bleeding (77% versus 89%; P = 0.009), and standard combination therapy was used less frequently (58% versus 70%; P = 0.079). Secondary prophylaxis failure was more frequent (50% versus 31%; P = 0.001) and survival significantly shorter in patients with HCC (median survival: 5 months versus greater than 38 months in patients without HCC; P < 0.001). Lack of prophylaxis increased rebleeding and mortality. On multivariate analysis Child‐Pugh score, presence of HCC, portal vein thrombosis, and lack of secondary prophylaxis were predictors of death. Conclusions : Patients with HCC and VB have worse prognosis than patients with VB without HCC. Secondary prophylaxis offers survival benefit in HCC patients. (H epatology 2013; 58:2079–2088)