Jung Hee Kim1, Dong Hyun Sinn2, Kyunga Kim3, Wonseok Kang1, Geum-Youn Gwak1, Yong-Han Paik1, Moon Seok Choi1, Joon Hyeok Lee1, Kwang Cheol Koh1, Seung Woon Paik1. 1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351, 81 Irwon-ro, Gangnam-gu, Seoul, Korea. 2. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351, 81 Irwon-ro, Gangnam-gu, Seoul, Korea. dh.sinn@samsung.com. 3. Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea.
Abstract
BACKGROUND AND AIMS: We evaluated the impact of primary variceal bleeding prophylaxis on long-term outcomes of patients newly diagnosed with hepatocellular carcinoma (HCC). METHODS: A retrospective cohort of 898 patients newly diagnosed with HCC without a history of variceal bleeding [age 57.4 ± 10.4, males 718 (80.0 %)] were analyzed for new onset variceal bleeding during follow-up. RESULTS: Variceal bleeding occurred in 72 patients (8.0 %) during follow-up. The presence of portal vein thrombosis [hazard ratio (HR) 3.90; 95 % confidence interval (CI) 2.09-7.30; p < 0.001] and the presence of the red color sign or ≥grade 2 varices at index endoscopy (HR 7.64; 95 % CI 4.56-12.80; p < 0.001) were independent risk factors for variceal bleeding. The occurrence of variceal bleeding was an independent risk factor for mortality (HR 1.39; 95 % CI 1.06-1.82; p = 0.015). The cumulative incidence rate of variceal bleeding at 1 year was 2.1, 15.3, and 34.2 % for those non-indicated for primary prophylaxis (n = 760), indicated for primary prophylaxis and received prophylaxis (n = 98), and indicated for primary prophylaxis but did not received prophylaxis (n = 40) (p < 0.001). Primary prophylaxis for variceal bleeding for indicated patients was associated with a reduced risk of mortality in all patients (HR 0.54; 95 % CI 0.33-0.88; p = 0.014) and in propensity-matched patients (HR, 0.54; 95 % CI 0.31-0.95; p = 0.033). CONCLUSION: Variceal bleeding was independent risk factor for survival of newly diagnosed HCC patients. Screening and providing primary prophylaxis for indicated patients should be considered for patients with HCC.
BACKGROUND AND AIMS: We evaluated the impact of primary variceal bleeding prophylaxis on long-term outcomes of patients newly diagnosed with hepatocellular carcinoma (HCC). METHODS: A retrospective cohort of 898 patients newly diagnosed with HCC without a history of variceal bleeding [age 57.4 ± 10.4, males 718 (80.0 %)] were analyzed for new onset variceal bleeding during follow-up. RESULTS: Variceal bleeding occurred in 72 patients (8.0 %) during follow-up. The presence of portal vein thrombosis [hazard ratio (HR) 3.90; 95 % confidence interval (CI) 2.09-7.30; p < 0.001] and the presence of the red color sign or ≥grade 2 varices at index endoscopy (HR 7.64; 95 % CI 4.56-12.80; p < 0.001) were independent risk factors for variceal bleeding. The occurrence of variceal bleeding was an independent risk factor for mortality (HR 1.39; 95 % CI 1.06-1.82; p = 0.015). The cumulative incidence rate of variceal bleeding at 1 year was 2.1, 15.3, and 34.2 % for those non-indicated for primary prophylaxis (n = 760), indicated for primary prophylaxis and received prophylaxis (n = 98), and indicated for primary prophylaxis but did not received prophylaxis (n = 40) (p < 0.001). Primary prophylaxis for variceal bleeding for indicated patients was associated with a reduced risk of mortality in all patients (HR 0.54; 95 % CI 0.33-0.88; p = 0.014) and in propensity-matched patients (HR, 0.54; 95 % CI 0.31-0.95; p = 0.033). CONCLUSION: Variceal bleeding was independent risk factor for survival of newly diagnosed HCC patients. Screening and providing primary prophylaxis for indicated patients should be considered for patients with HCC.
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