Prognostic factors of primary hepatocellular carcinoma / 解放军医学杂志

ABSTRACT

Objective To investigate the incidence of hepatocellular carcinoma (HCC) among patients with esophageal varices bleeding previously treated with endoscopic sclerotherapy, and to evaluate the factors influencing prognosis of HCC patients.Methods The clinical data of patients (from April 1987 to May 2003) who had received sclerotherapy for esophageal varices bleeding, and also that of HCC patients who had had sclerotherapy for esophageal varices bleeding were retrospectively reviewed. The survival rates of HCC patients were evaluated with Wilcoxon-Gehan method. Sixteen risk factors for HCC were assessed by multivariate analysis (Cox model). Results A total of 934 cases were treated with sclerotherapy, among which 109 patients suffered from HCC while 825 patients did not. In 22 HCC patients with esophageal varices bleeding sclerotherapy was not given. 31 out of 825 patients (3.76%) developed HCC during the follow-up period. 17 out of 31 patients received regular follow-up while 14 cases did not. The median surviving time of 31 patients was 13 months. The survival rate of patients with HCC under regular follow-up was significantly higher than that of patients under irregular follow-up(P=0.0002); risk factors, i.e. Child-Pugh classification, age and regular or irregular follow-up, were significantly related to the prognosis of patients with HCC(P=0.039、0.029 and 0.021, respectively). Conclusion Surveillance of patients with decompensated liver cirrhosis may increase the diagnostic rate of small HCC and prolong life expectancy; sclerotherapy can lower the incidence of HCC and it may play an active role in decreasing the incidence of HCC.