Shu-Yein Ho1,2,3, Po-Hong Liu3,4, Chia-Yang Hsu3,5, Chih-Chieh Ko3,6, Yi-Hsiang Huang3,6,7, Chien-Wei Su3,6, Cheng-Yuan Hsia3,8, Rheun-Chuan Lee3,9, Ming-Chih Hou3,6, Teh-Ia Huo2,3,10. 1. Division of Gastroenterology and Hepatology, Min-Sheng General Hospital, Taoyuan, Taiwan. 2. Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan. 3. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. 4. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 5. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA. 6. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 7. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. 8. Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. 9. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan. 10. Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Abstract
BACKGROUND: Patients with hepatocellular carcinoma (HCC) may develop end-stage renal disease and receive dialysis, but the impact of dialysis on the prognosis is unclear. This study aimed to evaluate the outcome of dialysis HCC patients and the prognostic role of albumin-bilirubin (ALBI) grade in these patients. METHODS: Among the consecutive 3,794 HCC patients between 2002-2017, 43 patients undergoing dialysis, and 129 age, sex-matched controls were analyzed. Multivariate Cox hazards model was used to identify independent prognostic predictors. RESULTS: Dialysis patients had decreased overall survival when compared with non-dialysis patients (n=3,751) and matched controls (n=129; each P=0.004). Patients with ALBI grade 1 had the best survival in the pooled cohort of dialysis and matched controls (n=172). In the Cox model, total tumor volume >33 cm3 [hazard ratio (HR): 6.763, P<0.001], presence of ascites (HR: 6.168, P<0.001), dialysis duration less than 24 months (HR: 3.144, P=0.006), diabetes-related dialysis (HR: 9.366, P=0.001) and non-curative treatments (HR: 9.220, P<0.001) were poor prognosis factors associated with increase mortality among dialysis patients. Of the 9 currently-used HCC staging systems, the CLIP score was the optimal cancer staging for dialysis patients. CONCLUSIONS: Patients receiving dialysis had decreased overall survival compared with non-dialysis patients. Longer duration of dialysis, non-diabetes related dialysis, absence of ascites, and curative treatments were associated with improved survival in these patients. The ALBI grade is a feasible prognostic model to evaluate liver functional reserve, and the CLIP model is the best staging system for dialysis patients with HCC. 2021 Journal of Gastrointestinal Oncology. All rights reserved.
BACKGROUND: Patients with hepatocellular carcinoma (HCC) may develop end-stage renal disease and receive dialysis, but the impact of dialysis on the prognosis is unclear. This study aimed to evaluate the outcome of dialysis HCC patients and the prognostic role of albumin-bilirubin (ALBI) grade in these patients. METHODS: Among the consecutive 3,794 HCC patients between 2002-2017, 43 patients undergoing dialysis, and 129 age, sex-matched controls were analyzed. Multivariate Cox hazards model was used to identify independent prognostic predictors. RESULTS: Dialysis patients had decreased overall survival when compared with non-dialysis patients (n=3,751) and matched controls (n=129; each P=0.004). Patients with ALBI grade 1 had the best survival in the pooled cohort of dialysis and matched controls (n=172). In the Cox model, total tumor volume >33 cm3 [hazard ratio (HR): 6.763, P<0.001], presence of ascites (HR: 6.168, P<0.001), dialysis duration less than 24 months (HR: 3.144, P=0.006), diabetes-related dialysis (HR: 9.366, P=0.001) and non-curative treatments (HR: 9.220, P<0.001) were poor prognosis factors associated with increase mortality among dialysis patients. Of the 9 currently-used HCC staging systems, the CLIP score was the optimal cancer staging for dialysis patients. CONCLUSIONS: Patients receiving dialysis had decreased overall survival compared with non-dialysis patients. Longer duration of dialysis, non-diabetes related dialysis, absence of ascites, and curative treatments were associated with improved survival in these patients. The ALBI grade is a feasible prognostic model to evaluate liver functional reserve, and the CLIP model is the best staging system for dialysis patients with HCC. 2021 Journal of Gastrointestinal Oncology. All rights reserved.