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Differential prognostic impact of renal insufficiency on patients with hepatocellular carcinoma: A propensity score analysis and staging strategy

Authors

  • Chia-Yang Hsu,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    3. Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
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  • Cheng-Yuan Hsia,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Yi-Hsiang Huang,

    1. Institutes of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Chien-Wei Su,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Han-Chieh Lin,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Yi-You Chiou,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Rheun-Chuan Lee,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Fa-Yauh Lee,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Teh-Ia Huo,

    Corresponding author
    1. Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
      Professor Teh-Ia Huo, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan. Email: tihuo@vghtpe.gov.tw
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  • Shou-Dong Lee

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Professor Teh-Ia Huo, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan. Email: tihuo@vghtpe.gov.tw

Abstract

Background and Aim:  Renal insufficiency (RI) can coexist in patients with hepatocellular carcinoma (HCC). This study analyzed the prognostic impact of RI on patients with HCC and determined the optimal staging strategy for these patients.

Methods:  RI was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. A total of 502 and 1701 HCC patients with and without RI, respectively, were enrolled. One-to-one matched patient cohorts according to treatments were built by using the propensity model. The prognostic ability of the Cancer of the Liver Italian Program, Barcelona Clinic Liver Cancer, Japan Integrated Scoring, and Taipei Integrated Scoring (TIS) systems in HCC patients with RI was compared by using the Akaike information criterion (AIC).

Results:  For patients undergoing percutaneous ablation and transarterial chemoembolization (TACE), RI was significantly associated with decreased long-term survival (P = 0.001 and 0.004, respectively). In patients receiving resection and other treatments, there were no significant survival differences between patients with and without RI. With similar demographics generated in the propensity model, significantly decreased survival was found in patients with RI in the TACE group (P = 0.018), but not in the resection, percutaneous ablation, and other treatment groups. Among HCC patients with RI, the TIS system had the lowest AIC value.

Conclusions:  RI is often present in patients with HCC and predicts a poor outcome in patients undergoing TACE. The survival of HCC patients receiving resection, percutaneous ablation, and other treatments is not affected by RI. The TIS staging system is a more feasible prognostic model for HCC patients with RI.

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