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THE KOREAN LIVER CANCER ASSOCIATION
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- Original Article Cause of Mortality for Hepatocellular Carcinoma Patients who were Diagnosed within the Milan Criteria
- Hyun-Woo Lee, Dong Hyun Sinn, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik
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Journal of Liver Cancer 2016;16(2):101-107
DOI: https://doi.org/10.17998/jlc.16.2.101
Published online: September 30, 2016
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Corresponding author:
Dong Hyun Sinn,
Email: dh.sinn@samsung.com
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Abstract
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.
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