High Tumor Burden: A Key Predictor of Poor Short-Term Prognosis after First Variceal Bleeding in Patients with Hepatocellular Carcinoma.

INTRODUCTION AND

Objectives

The short-term outcome and prognosis of the first-onset esophagogastric variceal bleeding patients with hepatocellular carcinoma (HCC) is still unclear. PATIENTS AND

Methods

This study retrospectively enrolled 1042 first-time hospitalized patients with cirrhosis from January 2010 to December 2020. A total of 1032 patients had esophagogastric variceal bleeding and 137 of them had HCC. Clinical, laboratory, and tumor characteristics were analyzed. Clinical characteristics and 4-week outcomes (mortality, rebleeding and the composite endpoint (death or rebleeding)) were analyzed.

Results

The overall 4-week mortality, rebleeding, and composite endpoint rates were 14.6% (20/137), 21.9% (30/137), and 29.2% (40/137), respectively. Multivariate analyses identified high tumor burden (OR: 7.97; 95% Confidence Interval: 2.84-26.17; p < 0.01) as an independent risk factor for 4-week mortality. The presence of portal vein thrombosis (OR: 3.07; 95% Confidence Interval: 1.35-7.17; p < 0.01) was an independent risk factor for rebleeding. For the composite endpoint, portal vein thrombosis (OR: 3.70; 95% Confidence Interval: 1.73-8.12; p < 0.01) was identified as an independent risk factor.

Conclusions

For HCC patients experiencing their first variceal bleeding, high tumor burden is the primary driver of short-term adverse prognosis. Acute in-hospital events warrant particular vigilance in patients with high tumor burden accompanied by portal vein thrombosis.