In patients with hepatocellular carcinoma (HCC) or liver cirrhosis (LC) accompanied by hepatitis E virus (HEV) infection, hepatic failure often leads to debility. Here, we report about a 63-year-old man with alcoholic LC who was referred to our hospital with jaundice and abdominal distension 10 days earlier. Abdominal computed tomography showed necrotic HCC accompanied by left lobe shrinkage without tumor progression. Laboratory and imaging findings revealed no acute infection focus. The patient reported no herbal medicine or alcohol consumption, and there was no evidence of acute viral hepatitis. One month later, HEV immunoglobulin M positivity was confirmed, and deterioration of liver function due to HEV infection was suspected. The patient often ate raw oysters and sashimi, as well as boar meat, which is a well-known risk food for HEV infection. His umbilical hernia deteriorated due to tense ascites and infection by skin abrasion. The patient progressed to hepatorenal syndrome and eventually died. Liver function preservation is important when treating HCC patients. Therefore, clinicians should pay more attention to the prevention of HEV and others causes of direct liver injury.
Background/Aims Hepatocellular carcinoma (HCC) is a unique condition where the cause of
death might not only be due to progressive cancer, but also from liver failure. We evaluated
specific causes of death for HCC patients who were initially diagnosed within the Milan criteria. Methods A retrospective cohort of 147 patients with mortality who were initially diagnosed
with HCC within the Milan criteria between January 2008 and December 2012 at a single
institution was reviewed. Results During follow-up, 104 patients (70.7%) experienced one or more cirrhotic complications,
such as ascites, variceal bleeding, or hepatic encephalopathy. Near mortality, cancer progression
(exceeding the Milan criteria) was recorded for 102 patients (69.3%), while cirrhosis progression
(greater than two-point increase in Child-Pugh score) was noted in 110 (74.8%) patients. Alphafetoprotein,
protein-induced by vitamin K antagonist-II levels and treatment modality were
associated with cancer progression, while age and Child-Pugh class were associated with
cirrhosis progression. There were 61 patients with in-hospital mortality; cancer progression
plus liver failure was noted in 34 patients (55.7%), liver failure without cancer progression was
seen in 20 patients (32.8%), and only four patients (6.6%) showed mortality from extrahepatic
metastasis without liver failure. Conclusions Among HCC patients who were diagnosed within the Milan criteria, most of them
had cirrhosis progression near mortality, and significant proportion died without uncontrolled
cancer growth, mainly due to liver failure. These findings show the importance of liver function
that should be considered in managing HCC patients.
Citations
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Liver resection is an important curable treatment modality for patient with early hepatocelluar carcinoma (HCC)
with good underlying liver function. Recently, mortality after liver resection for HCC became low, however
morbidity is still significantly high. Liver failure is the most serious complication of liver resection. We report a
case of liver failure following liver resection for hepatocellular carcinoma who recovered spontaneously.