Clinical Outcome and Predictive Factors of Variceal Bleeding in Patients with Hepatocellular Carcinoma in Thailand

Abstract

Objective: Hepatocellular carcinoma (HCC) is common cancer in ASEAN. Variceal bleeding (VB) is considered<br />to be fatal complication of cirrhosis with HCC. However, limited studies were reported in ASEAN. Aim of this study<br />was to evaluate overall survival rate and predictors of VB in HCC patients. Methods: We conducted a retrospective<br />cohort study of HCC patients aged ≥15 years between January 2012-January 2016 and follow up through June 2016 at<br />Thammasat University Hospital, Thailand. Clinical information and radiologic findings were collected from reviewing<br />computer database of medical records. Results: 333 patients had completely retrievable information. Of which, 27<br />patients (8.1%) had documented with VB. Clinical presentations with weight loss and jaundice were higher in VB than<br />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.<br />The most common causes of cirrhosis in HCC patients with VB were chronic HBV infection (55.56%). In multivariate<br />analysis; presence of ascites, Child-Pugh score>6, presence of varices were independent risk factors of having VB in<br />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-<br />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%.<br />Conclusions: HCC patients with ascites, Child-Pugh score>6 and presence of varices might be important predictive<br />factors of VB. Having VB were greatly impact to the survival rate of HCC patients. Clinical suspicion and regular<br />surveillance of VB in HCC patients at risk could improve treatment outcomes.