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Rebleeding prophylaxis improves outcomes in patients with hepatocellular carcinoma. A multicenter case-control study.
Ripoll, Cristina; Genescà, Joan; Araujo, Isis K.; Graupera, Isabel; Augustin, Salvador; Tejedor, Marta; Cirera, Isabel; Aracil, Carles; Sala, Margarita; Hernandez-Guerra, Manuel; Llop, Elba; Escorsell i Mañosa, M. Àngels; Catalina, M. V.; Cañete, Núria; Albillos, Agustín; Villanueva Sánchez, Càndid; González-Abraldes Iglesias, Juan; Bañares, Rafael; Bosch i Genover, Jaume
Universitat de Barcelona
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
Càncer de fetge
Varices esofàgiques
Assaigs clínics
Liver cancer
Esophageal varices
Clinical trials
(c) American Association for the Study of Liver Diseases, 2013

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