Characteristics and Prognosis of Hepatocellular Carcinoma in Japanese Patients Undergoing Dialysis

Toyoda, Hidenori; Hiraoka, Atsushi; Tada, Toshifumi; Michitaka, Kojiro; Takaguchi, Koichi; Tsuji, Kiichiro; Itobayashi, Ei; Takizawa, Daichi; Hirooka, Masashi; Ochi, Hironori; Joko, Koji; Kisaka, Yoshiyasu; Shimizu, Yuko; Tajiri, Kazuto; Tani, Joji; Taniguchi, Tatsuya; Toshimori, Akiko; Fujioka, Shinichi; Kumada, Takashi

doi:10.1111/1744-9987.12563

Cited by 15 publications

(15 citation statements)

References 39 publications

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“…We also evaluated the prognostic determinants in solely dialysis patients with HCC and found that larger TTV, ascites, duration of dialysis ≤24 months, diabetes-related cause of dialysis, and non-curative treatments were associated with decreased long-term survival. These results were largely consistent with previous studies (24)(25)(26). Notably, those with shorter duration of dialysis were associated with poor outcome.…”

Section: Discussionsupporting

confidence: 92%

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ALBI grade in dialysis patients with hepatocellular carcinoma: prognostic impact and staging strategy

Ho¹,

Liu²,

Hsu³

et al. 2021

J Gastrointest Oncol

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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 cm 3 [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 9currently-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.

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Section: Discussionsupporting

confidence: 92%

“…Previous studies reported comparable survival rates between dialysis and non-dialysis patients with HCC (5,24). By contrast, another study from Japan revealed that patients receiving dialysis had lower survival rate compared with non-dialysis patients (25). Therefore, the prognosis of HCC patients with dialysis was highly debated.…”

Section: Discussionmentioning

confidence: 99%

ALBI grade in dialysis patients with hepatocellular carcinoma: prognostic impact and staging strategy

Ho¹,

Liu²,

Hsu³

et al. 2021

J Gastrointest Oncol

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“…In this study, only a small proportion (3.6%) of RI patients received dialysis. Consistently, we found that patients without dialysis survived longer than patients with dialysis [36]. However, the impact of dialysis requires further large-scale studies to confirm.…”

Section: Discussionsupporting

confidence: 81%

Survival of Patients with Hepatocellular Carcinoma in Renal Insufficiency: Prognostic Role of Albumin-Bilirubin Grade

Hsu

Liu

et al. 2020

Cancers

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Renal insufficiency (RI) is commonly seen in patients with hepatocellular carcinoma (HCC). The prognostic role of albumin-bilirubin (ALBI) grade in this special setting is unclear. We aimed to investigate the role of ALBI grade associated with the impact of RI on HCC. A prospective cohort of 3690 HCC patients between 2002 and 2016 were retrospectively analyzed. The Kaplan–Meier method and multivariate Cox proportional hazards model were used to determine survival and independent prognostic predictors. Of all patients, RI was an independent predictor associated with decreased survival. In multivariate Cox analysis for patients with RI, α-fetoprotein level ≥20 ng/mL, tumor size >3 cm, vascular invasion, distant metastasis, presence of ascites, performance status 1–2, performance status 3–4, and ALBI grade 2 and grade 3 were independent predictors of decreased survival (all p < 0.05). In subgroup analysis of patients with RI undergoing curative and non-curative treatments, the ALBI grade remained a significant prognostic predictor associated with decreased survival (p < 0.001). In summary, HCC patients with RI have decreased survival compared to those without RI. The ALBI grade can discriminate the survival in patients with RI independent of treatment strategy and is a feasible prognostic tool in this special patient population.

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“…In fact, patients on haemodialysis are frequently not screened for HCC, even if a considerable percentage of them, especially those who are HCV positive, are at risk of HCC. 119 Therefore, a collaborative effort among HCC and CKD specialists is crucial to improve patient outcomes ( Table 2).…”

Section: Patients Undergoing Haemodialysismentioning

confidence: 99%

Systemic treatment of HCC in special populations

Rimassa

Personeni

Czauderna

et al. 2021

Journal of Hepatology

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Recent years have seen significant progress in the systemic treatment of hepatocellular carcinoma (HCC), including the advent of immunotherapy. While several large phase III trials have provided the evidence for a multi-line treatment paradigm, they have focused on a highly selected group of patients by excluding potentially confounding comorbidities. As a result, high quality evidence for the systemic treatment of HCC in patients with various comorbidities is missing. This review summarises current knowledge on the use of approved medicines in patients with HIV, autoimmune disease, cardiovascular disease, diabetes, fibrolamellar HCC, mixed HCC-cholangiocarcinoma, decompensated cirrhosis (Child-Pugh B and C), a significant bleeding history, vascular invasion or portal vein thrombosis, as well as the elderly, those on haemodialysis, and those after solid organ transplantation. The article highlights relevant knowledge gaps and current clinical challenges. To improve the safety and efficacy of HCC treatment in these subgroups, future trials should be designed to specifically include patients with comorbidities.

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Characteristics and Prognosis of Hepatocellular Carcinoma in Japanese Patients Undergoing Dialysis

Cited by 15 publications

References 39 publications

ALBI grade in dialysis patients with hepatocellular carcinoma: prognostic impact and staging strategy

ALBI grade in dialysis patients with hepatocellular carcinoma: prognostic impact and staging strategy

Survival of Patients with Hepatocellular Carcinoma in Renal Insufficiency: Prognostic Role of Albumin-Bilirubin Grade

Systemic treatment of HCC in special populations

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