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

doi:10.17998/jlc.16.2.101

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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; Journal of Liver Cancer 2016;16(2):101-107
DOI: https://doi.org/10.17998/jlc.16.2.101
Published online: September 30, 2016

Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Corresponding author: Dong Hyun Sinn,
Email: dh.sinn@samsung.com

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Abstract

Background/Aim
s: 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.

Keywords: Hepatocellular carcinoma;Cause of death;Liver failure

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