Conflict of interest: none
Hepatocellular carcinoma in uremic patients: Is there evidence for an increased risk of mortality?
Article first published online: 22 JAN 2013
© 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 28, Issue 2, pages 348–356, February 2013
How to Cite
Lee, Y.-H., Hsu, C.-Y., Hsia, C.-Y., Huang, Y.-H., Su, C.-W., Lin, H.-C., Lee, R.-C., Chiou, Y.-Y. and Huo, T.-I. (2013), Hepatocellular carcinoma in uremic patients: Is there evidence for an increased risk of mortality?. Journal of Gastroenterology and Hepatology, 28: 348–356. doi: 10.1111/jgh.12062
Financial support: This study was supported by grants (DOH101-TD-C-111-007) from the Center of Excellence for Cancer Research at Taipei Veterans General Hospital, Taiwan, from Taipei Veterans General Hospital (V101C-170), Taipei, Taiwan, and from the Ministry of Education, Aim for the Top University Plan (101AC-D101), Taiwan.
- Issue published online: 22 JAN 2013
- Article first published online: 22 JAN 2013
- Accepted manuscript online: 28 NOV 2012 07:19AM EST
- Manuscript Accepted: 2 OCT 2012
- Center of Excellence for Cancer Research at Taipei Veterans General Hospital, Taiwan. Grant Number: DOH101-TD-C-111-007
- Taipei Veterans General Hospital. Grant Number: V101C-170
- Ministry of Education, Aim for the Top University Plan. Grant Number: 101AC-D101
- end-stage renal disease;
- hepatocellular carcinoma;
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.
A total of 2502 HCC patients, including 30 dialysis patients and 90 age, sex, and treatment-matched controls were retrospectively analyzed.
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 Cox 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 Child-Turcotte-Pugh (CTP) provided a better prognostic ability than the MELD system. Among the four currently used staging systems, the Japan Integrated Scoring (JIS) system was a more accurate prognostic model for dialysis patients; a JIS score ≥ 2 significantly predicted a worse survival (P = 0.024).
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.