Editor’s note: From November 10th to 14th, 2023, the annual highlight of the liver disease field, the American Association for the Study of Liver Diseases (AASLD) Annual Meeting 2023, was grandly held in Boston, USA. Several research achievements from Dr. Xuefeng Luo’s team at West China Hospital of Sichuan University were included in the conference [1-3], with one poster earning the distinction of “Poster of Distinction.” International Liver Disease hereby reports on the team’s latest findings exploring the clinical outcomes and prognostic factors in patients with acute variceal bleeding (AVB) combined with liver cell carcinoma (HCC) and liver cirrhosis, providing valuable insights for readers.
▲AASLD2023壁报展示（3153-A）
Research Background
Acute variceal bleeding (AVB) is a common and life-threatening complication of liver cirrhosis, with a 6-week mortality rate as high as 15%-20%. Previous studies have identified the presence of liver cell carcinoma (HCC) as one of the risk factors for poor prognosis in AVB patients. However, further clarification is needed regarding the clinical characteristics and outcomes of such patients. Therefore, this study aimed to describe the clinical features, treatment, and prognosis of AVB patients with concomitant HCC and explore the risk factors influencing their prognosis.
Research Methods
This study is a single-center case-control study. It retrospectively included AVB patients with HCC who were continuously treated at West China Hospital of Sichuan University from January 2016 to December 2019. The control group consisted of AVB patients without HCC, matched 1:1 based on age, gender, and Child-Pugh grading, who were treated at the same hospital during the same period. Data on patients’ clinical characteristics, treatment, and prognosis were collected. The primary outcome was the 6-week mortality rate, with secondary outcomes including the 5-day treatment failure rate and 1-year mortality rate. A multifactorial Cox regression model was used to analyze the 6-week mortality rate.
Research Results
A total of 143 AVB patients with HCC were included in this study, with a matched control group of 143 AVB patients without HCC from the same period. The HCC group exhibited significantly higher 6-week and 1-year mortality rates compared to the control group (26.6% vs. 12.6%, P=0.003; 53.3% vs. 18.9%, P<0.001) (Figure 1 and Figure 2).
Research Background
Acute variceal bleeding (AVB) is a common and life-threatening complication of liver cirrhosis, with a 6-week mortality rate as high as 15%-20%. Previous studies have identified the presence of liver cell carcinoma (HCC) as one of the risk factors for poor prognosis in AVB patients. However, further clarification is needed regarding the clinical characteristics and outcomes of such patients. Therefore, this study aimed to describe the clinical features, treatment, and prognosis of AVB patients with concomitant HCC and explore the risk factors influencing their prognosis.
Research Methods
This study is a single-center case-control study. It retrospectively included AVB patients with HCC who were continuously treated at West China Hospital of Sichuan University from January 2016 to December 2019. The control group consisted of AVB patients without HCC, matched 1:1 based on age, gender, and Child-Pugh grading, who were treated at the same hospital during the same period. Data on patients’ clinical characteristics, treatment, and prognosis were collected. The primary outcome was the 6-week mortality rate, with secondary outcomes including the 5-day treatment failure rate and 1-year mortality rate. A multifactorial Cox regression model was used to analyze the 6-week mortality rate.
Research Results
A total of 143 AVB patients with HCC were included in this study, with a matched control group of 143 AVB patients without HCC from the same period. The HCC group exhibited significantly higher 6-week and 1-year mortality rates compared to the control group (26.6% vs. 12.6%, P=0.003; 53.3% vs. 18.9%, P<0.001) (Figure 1 and Figure 2).
To further explore the factors influencing the prognosis of the HCC group, the researchers found that alpha-fetoprotein (AFP) levels (HR: 1.001; 95% CI: 1.000–1.002; P=0.001), Barcelona Clinic Liver Cancer (BCLC) clinical staging (C-D vs. 0-B) (HR: 8.753; 95% CI: 1.934–39.612; P=0.005), and Child-Pugh score (HR: 1.503, 95% CI: 1.235–1.830; P<0.001) were independent risk factors for 6-week mortality (Table 1).
Table 1. Univariate and Multivariate COX Regression Model Analysis of 6-week Mortality in AVB Patients with HCC
Furthermore, based on Child-Pugh scoring and BCLC staging, the researchers stratified patients in the HCC group according to risk. The results showed that patients with Child-Pugh ≥9 points and BCLC stage C-D had a 6-week mortality rate of 71.4% (Figure 3).
Research Conclusion
This study indicates that, compared to AVB patients without concomitant HCC, those with HCC have poorer clinical outcomes and prognosis. The severity of liver function and tumor staging are identified as the primary risk factors for mortality in these patients.
Medical Doctor, Associate Professor, Doctoral Supervisor
