Hepatology International

, Volume 7, Issue 1, pp 188–198

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

Authors

  • Chia-Yang Hsu
    • Division of Gastroenterology, Department of MedicineTaipei Veterans General Hospital
    • Department of MedicineNational Yang-Ming University Hospital
    • National Yang-Ming University School of Medicine
  • Yun-Hsuan Lee
    • Division of Gastroenterology, Department of MedicineTaipei Veterans General Hospital
    • National Yang-Ming University School of Medicine
  • Yi-Hsiang Huang
    • Division of Gastroenterology, Department of MedicineTaipei Veterans General Hospital
    • National Yang-Ming University School of Medicine
  • Cheng-Yuan Hsia
    • Division of Gastroenterology, Department of MedicineTaipei Veterans General Hospital
    • Department of SurgeryTaipei Veterans General Hospital
    • National Yang-Ming University School of Medicine
  • Chien-Wei Su
    • Division of Gastroenterology, Department of MedicineTaipei Veterans General Hospital
    • National Yang-Ming University School of Medicine
  • Han-Chieh Lin
    • Division of Gastroenterology, Department of MedicineTaipei Veterans General Hospital
    • National Yang-Ming University School of Medicine
  • Rheun-Chuan Lee
    • Department of RadiologyTaipei Veterans General Hospital
    • National Yang-Ming University School of Medicine
  • Yi-You Chiou
    • Department of RadiologyTaipei Veterans General Hospital
    • National Yang-Ming University School of Medicine
  • Fa-Yauh Lee
    • Division of Gastroenterology, Department of MedicineTaipei Veterans General Hospital
    • National Yang-Ming University School of Medicine
    • Division of Gastroenterology, Department of MedicineTaipei Veterans General Hospital
    • National Yang-Ming University School of Medicine
  • Shou-Dong Lee
    • Division of Gastroenterology, Department of MedicineTaipei Veterans General Hospital
    • National Yang-Ming University School of Medicine
Original Article

DOI: 10.1007/s12072-011-9338-z

Cite this article as:
Hsu, C., Lee, Y., Huang, Y. et al. Hepatol Int (2013) 7: 188. doi:10.1007/s12072-011-9338-z

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

AscitesHepatocellular carcinomaLiver cirrhosisMELD

Abbreviations

AFP

α-Fetoprotein

AIC

Akaike information criterion

BCLC

Barcelona Clinic Liver Cancer

CI

Confidence interval

CLIP

Cancer of the Liver Italian Program

CT

Computed tomography

CTP

Child–Turcotte–Pugh

HBV

Hepatitis B virus

HCV

Hepatitis C virus

HCC

Hepatocellular carcinoma

INR

International normalized ratio

JIS

Japan Integrated Scoring

MELD

Model for end-stage liver disease

PAI

Percutaneous acetic acid injection

PEI

Percutaneous ethanol injection

RFA

Radiofrequency ablation

SD

Standard deviation

TACE

Transarterial chemoembolization

Copyright information

© Asian Pacific Association for the Study of the Liver 2012