Chia-Yang Hsu1,2,3, Yun-Hsuan Lee1,3, Yi-Hsiang Huang1,3, Cheng-Yuan Hsia1,4,3, Chien-Wei Su1,3, Han-Chieh Lin1,3, Rheun-Chuan Lee5,3, Yi-You Chiou5,3, Fa-Yauh Lee1,3, Teh-Ia Huo6,7, Shou-Dong Lee1,3. 1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan. 2. Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan. 3. National Yang-Ming University School of Medicine, Taipei, Taiwan. 4. Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. 5. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan. 6. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan. tihuo@vghtpe.gov.tw. 7. National Yang-Ming University School of Medicine, Taipei, Taiwan. tihuo@vghtpe.gov.tw.
Abstract
PURPOSE: Ascites may develop in patients with hepatocellular carcinoma (HCC) with coexisting liver cirrhosis. Few studies had specifically evaluated the role of ascites in HCC. This study investigated its prevalence, associated factors, prognostic impact, and staging strategy in a large HCC patient cohort. PATIENTS AND METHODS: A total of 2,203 HCC patients were analyzed. The grading of ascites was according to the European Association for the Study of Liver. The prognostic ability of the Cancer of the liver Italian Program (CLIP), Barcelona Clinic Liver Cancer, Japan Integrated Scoring system, and Taipei Integrated Scoring system in HCC patients with ascites was compared using the Akaike information criterion (AIC). RESULTS: Ascites was present in 498 (23%) patients at diagnosis. Grades 1, 2, and 3 ascites were found in 13, 5, and 5% of the patients, respectively. The severity of ascites significantly correlated with hyperbilirubinemia, hypoalbuminemia, hyponatremia, prothrombin time (PT) prolongation, and renal insufficiency (all p < 0.001). Large tumor burden and more frequent vascular invasion were often observed in patients with more severe ascites (both p < 0.001). In the Cox proportional hazard model, ascites was identified as an independent prognostic predictor with 80-94% increased risk of mortality (p < 0.001). Among HCC patients with ascites, the CLIP system had the lowest AIC value. CONCLUSIONS: Ascites is often seen in HCC patients and is associated with both tumoral and cirrhosis factors and decreased long-term survival. The CLIP staging system is a more feasible prognostic model for HCC patients with ascites. The optimal treatment strategy for these patients remains to be investigated.
PURPOSE:Ascites may develop in patients with hepatocellular carcinoma (HCC) with coexisting liver cirrhosis. Few studies had specifically evaluated the role of ascites in HCC. This study investigated its prevalence, associated factors, prognostic impact, and staging strategy in a large HCCpatient cohort. PATIENTS AND METHODS: A total of 2,203 HCCpatients were analyzed. The grading of ascites was according to the European Association for the Study of Liver. The prognostic ability of the Cancer of the liver Italian Program (CLIP), Barcelona Clinic Liver Cancer, Japan Integrated Scoring system, and Taipei Integrated Scoring system in HCCpatients with ascites was compared using the Akaike information criterion (AIC). RESULTS:Ascites was present in 498 (23%) patients at diagnosis. Grades 1, 2, and 3 ascites were found in 13, 5, and 5% of the patients, respectively. The severity of ascites significantly correlated with hyperbilirubinemia, hypoalbuminemia, hyponatremia, prothrombin time (PT) prolongation, and renal insufficiency (all p < 0.001). Large tumor burden and more frequent vascular invasion were often observed in patients with more severe ascites (both p < 0.001). In the Cox proportional hazard model, ascites was identified as an independent prognostic predictor with 80-94% increased risk of mortality (p < 0.001). Among HCCpatients with ascites, the CLIP system had the lowest AIC value. CONCLUSIONS:Ascites is often seen in HCCpatients and is associated with both tumoral and cirrhosis factors and decreased long-term survival. The CLIP staging system is a more feasible prognostic model for HCCpatients with ascites. The optimal treatment strategy for these patients remains to be investigated.
Authors: Ju Dong Yang; W Ray Kim; Ritika Coelho; Teresa A Mettler; Joanne T Benson; Schuyler O Sanderson; Terry M Therneau; Bohyun Kim; Lewis R Roberts Journal: Clin Gastroenterol Hepatol Date: 2010-09-08 Impact factor: 11.382
Authors: P Tangkijvanich; N Anukulkarnkusol; P Suwangool; S Lertmaharit; O Hanvivatvong; P Kullavanijaya; Y Poovorawan Journal: J Clin Gastroenterol Date: 2000-12 Impact factor: 3.062