Original Article

Hepatology International

, Volume 7, Issue 1, pp 188-198

Ascites in patients with hepatocellular carcinoma: prevalence, associated factors, prognostic impact, and staging strategy

  • Chia-Yang HsuAffiliated withDivision of Gastroenterology, Department of Medicine, Taipei Veterans General HospitalDepartment of Medicine, National Yang-Ming University HospitalNational Yang-Ming University School of Medicine
  • , Yun-Hsuan LeeAffiliated withDivision of Gastroenterology, Department of Medicine, Taipei Veterans General HospitalNational Yang-Ming University School of Medicine
  • , Yi-Hsiang HuangAffiliated withDivision of Gastroenterology, Department of Medicine, Taipei Veterans General HospitalNational Yang-Ming University School of Medicine
  • , Cheng-Yuan HsiaAffiliated withDivision of Gastroenterology, Department of Medicine, Taipei Veterans General HospitalDepartment of Surgery, Taipei Veterans General HospitalNational Yang-Ming University School of Medicine
  • , Chien-Wei SuAffiliated withDivision of Gastroenterology, Department of Medicine, Taipei Veterans General HospitalNational Yang-Ming University School of Medicine
  • , Han-Chieh LinAffiliated withDivision of Gastroenterology, Department of Medicine, Taipei Veterans General HospitalNational Yang-Ming University School of Medicine
  • , Rheun-Chuan LeeAffiliated withDepartment of Radiology, Taipei Veterans General HospitalNational Yang-Ming University School of Medicine
  • , Yi-You ChiouAffiliated withDepartment of Radiology, Taipei Veterans General HospitalNational Yang-Ming University School of Medicine
  • , Fa-Yauh LeeAffiliated withDivision of Gastroenterology, Department of Medicine, Taipei Veterans General HospitalNational Yang-Ming University School of Medicine
    • , Teh-Ia HuoAffiliated withDivision of Gastroenterology, Department of Medicine, Taipei Veterans General HospitalNational Yang-Ming University School of Medicine Email author 
    • , Shou-Dong LeeAffiliated withDivision of Gastroenterology, Department of Medicine, Taipei Veterans General HospitalNational Yang-Ming University School of Medicine

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Abstract

Purpose

Ascites may develop in patients with hepatocellular carcinoma (HCC) with coexisting liver cirrhosis. Few studies had specifically evaluated the role of ascites in HCC. This study investigated its prevalence, associated factors, prognostic impact, and staging strategy in a large HCC patient cohort.

Patients and methods

A total of 2,203 HCC patients were analyzed. The grading of ascites was according to the European Association for the Study of Liver. The prognostic ability of the Cancer of the liver Italian Program (CLIP), Barcelona Clinic Liver Cancer, Japan Integrated Scoring system, and Taipei Integrated Scoring system in HCC patients with ascites was compared using the Akaike information criterion (AIC).

Results

Ascites was present in 498 (23%) patients at diagnosis. Grades 1, 2, and 3 ascites were found in 13, 5, and 5% of the patients, respectively. The severity of ascites significantly correlated with hyperbilirubinemia, hypoalbuminemia, hyponatremia, prothrombin time (PT) prolongation, and renal insufficiency (all p < 0.001). Large tumor burden and more frequent vascular invasion were often observed in patients with more severe ascites (both p < 0.001). In the Cox proportional hazard model, ascites was identified as an independent prognostic predictor with 80–94% increased risk of mortality (p < 0.001). Among HCC patients with ascites, the CLIP system had the lowest AIC value.

Conclusions

Ascites is often seen in HCC patients and is associated with both tumoral and cirrhosis factors and decreased long-term survival. The CLIP staging system is a more feasible prognostic model for HCC patients with ascites. The optimal treatment strategy for these patients remains to be investigated.

Keywords

Ascites Hepatocellular carcinoma Liver cirrhosis MELD