Clinical Outcome and Predictive Factors of Variceal Bleeding in Patients with Hepatocellular Carcinoma in Thailand

Document Type : Research Articles


1 Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand.

2 Patumwan Demonstration School, Srinakharinwirot University, Bangkok, Thailand.

3 Gastric Cancer and Gastrointestinal Diseases Research Center, Pathumthani, Thailand.

4 Department of Medicine, Chulabhorn International College of Medicine (CICM) at Thammasat University, Pathumthani, Thailand.


Objective: Hepatocellular carcinoma (HCC) is common cancer in ASEAN. Variceal bleeding (VB) is considered
to be fatal complication of cirrhosis with HCC. However, limited studies were reported in ASEAN. Aim of this study
was to evaluate overall survival rate and predictors of VB in HCC patients. Methods: We conducted a retrospective
cohort study of HCC patients aged ≥15 years between January 2012-January 2016 and follow up through June 2016 at
Thammasat University Hospital, Thailand. Clinical information and radiologic findings were collected from reviewing
computer database of medical records. Results: 333 patients had completely retrievable information. Of which, 27
patients (8.1%) had documented with VB. Clinical presentations with weight loss and jaundice were higher in VB than
non-VB groups (40.74% vs. 34.64%, p=0.525 and 7.41% vs. 2.29%, p=0.116) but the differences were not significant.
The most common causes of cirrhosis in HCC patients with VB were chronic HBV infection (55.56%). In multivariate
analysis; presence of ascites, Child-Pugh score>6, presence of varices were independent risk factors of having VB in
HCC patients (OR=7.59, 95%CI=1.13-50.88, p=0.037; OR=5.07, 95%CI=1.08-23.76, p=0.039; OR=23.51, 95%CI=4.71-
117.35, p<0.001, respectively). In HCC patients with VB, 1-year and 2.5-year survival rates were 56.6% and 28.3%.
Conclusions: HCC patients with ascites, Child-Pugh score>6 and presence of varices might be important predictive
factors of VB. Having VB were greatly impact to the survival rate of HCC patients. Clinical suspicion and regular
surveillance of VB in HCC patients at risk could improve treatment outcomes.




Main Subjects

Volume 19, Issue 11
November 2018
Pages 3301-3305
  • Receive Date: 25 July 2018
  • Revise Date: 28 October 2018
  • Accept Date: 19 October 2018
  • First Publish Date: 01 November 2018