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

Authors

  • Yun-Hsuan 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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  • 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
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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. Institute 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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  • 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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  • 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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  • Teh-Ia Huo

    Corresponding author
    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan
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  • Conflict of interest: none
  • 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.

Correspondence

Dr Teh-Ia Huo, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan. Email: tihuo@vghtpe.gov.tw

Abstract

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 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).

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.

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