Hepatocellular carcinoma in uremic patients: Is there evidence for an increased risk of mortality?

Background and Aim The clinical aspects of patients with hepatocellular carcinoma ( HCC ) undergoing maintenance dialysis are largely unknown. We aimed to investigate the long‐term survival and prognostic determinants of dialysis patients with HCC . Methods A total of 2502 HCC patients, including 30 dialysis patients and 90 age, sex, and treatment‐matched controls were retrospectively analyzed. Results Dialysis patients more often had dual viral hepatitis B and C , lower serum α‐fetoprotein level, worse performance status, higher model for end‐stage liver disease ( MELD ) score than non‐dialysis patients and matched controls ( P all < 0.05). There was no significant difference in long‐term survival between dialysis and non‐dialysis patients and matched controls ( P  = 0.684 and 0.373, respectively). In the C ox proportional hazards model, duration of dialysis < 40 months (hazard ratio [ HR ]: 6.67, P  = 0.019) and ascites ( HR : 5.275, P  = 0.019) were independent predictors of poor prognosis for dialysis patients with HCC . Survival analysis disclosed that the C hild‐ T urcotte‐ P ugh ( CTP ) provided a better prognostic ability than the MELD system. Among the four currently used staging systems, the J apan I ntegrated S coring ( JIS ) system was a more accurate prognostic model for dialysis patients; a JIS score ≥ 2 significantly predicted a worse survival ( P  = 0.024). Conclusions Patients with HCC undergoing maintenance dialysis do not have a worse long‐term survival. A longer duration of dialysis and absence of ascites formation are associated with a better outcome in dialysis patients. The CTP classification is a more feasible prognostic marker to indicate the severity of cirrhosis, and the JIS system may be a better staging model for outcome prediction.