Journal article
Rebleeding Prophylaxis Improves Outcomes in Patients With Hepatocellular Carcinoma: A Multicenter Case-Control Study
Hepatology (Baltimore, Md.), Vol.58(6), pp.2079-2088
12/2013
DOI: 10.1002/hep.26629
PMID: 23908019
Abstract
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. (Hepatology 2013; 58:2079-2088)
Details
- Title: Subtitle
- Rebleeding Prophylaxis Improves Outcomes in Patients With Hepatocellular Carcinoma: A Multicenter Case-Control Study
- Creators
- Cristina Ripoll - Hospital General Universitario Gregorio MarañónJoan Genesca - Universitat Autònoma de BarcelonaIsis K. Araujo - Universitat de BarcelonaIsabel Graupera - Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasSalvador Augustin - Universitat Autònoma de BarcelonaMarta Tejedor - Hospital Universitario Ramón y CajalIsabel Cirera - Universitat Autònoma de BarcelonaCarles Aracil - Hospital Universitari Arnau de VilanovaMargarita Sala - Hospital Universitari Germans Trias i PujolManuel Hernandez-Guerra - Hosp Univ Canarias, Serv Aparato Digest, Tenerife, SpainElba Llop - Hospital Universitario Puerta de Hierro MajadahondaAngels Escorsell - Universitat de BarcelonaMaría Vega Catalina - Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y DigestivasNuria Canete - Universitat Autònoma de BarcelonaAgustin Albillos - Hospital Universitario Ramón y CajalCandid VillanuevaJuan G. Abraldes - Universitat de BarcelonaRafael Banares - Hospital General Universitario Gregorio MarañónJaime Bosch - Universitat de Barcelona
- Resource Type
- Journal article
- Publication Details
- Hepatology (Baltimore, Md.), Vol.58(6), pp.2079-2088
- Publisher
- Wiley
- DOI
- 10.1002/hep.26629
- PMID
- 23908019
- ISSN
- 0270-9139
- eISSN
- 1527-3350
- Number of pages
- 10
- Language
- English
- Date published
- 12/2013
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984695685102771
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