Impact of comorbid renal dysfunction in patients with hepatocellular carcinoma on long-term outcomes after curative resection

Abstract

BACKGROUND Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. However, the number of patients with chronic kidney disease (CKD) is on the rise because of the increase in lifestyle-related diseases. AIM To establish a tailored management strategy for HCC patients, we evaluated the impact of comorbid renal dysfunction (RD), as stratified by using the estimated glomerular filtration rate (EGFR), and assessed the oncologic validity of hepatectomy for HCC patients with RD. METHODS We enrolled 800 HCC patients who underwent hepatectomy between 1997 and 2015 at our university hospital. We categorized patients into two (RD, EGFR < 60 mL/min/1.73 m 2 ; non-RD, EGFR ≥ 60 mL/min/1.73 m 2 ) and three groups (severe CKD, EGFR < 30 mL/min/1.73 m 2 ; mild CKD, 30 ≤ EGFR < 60 mL/min/1.73 m 2 ; control, EGFR ≥ 60 mL/min/1.73 m 2 ) according to renal function as defined by the EGFR. Overall survival (OS) and recurrence-free survival (RFS) were compared among these groups with the log-rank test, and we also analyzed survival by using a propensity score matching (PSM) model to exclude the influence of patient characteristics. The mean postoperative observation period was 64.7 ± 53.0 mo. RESULTS The RD patients were significantly older and had lower serum total bilirubin, aspartate aminotransferase, and aspartate aminotransferase levels than the non-RD patients ( P < 0.0001, P < 0.001, P < 0.05, and P < 0.01, respectively). No patient received maintenance hemodialysis after surgery. Although the overall postoperative complication rates were similar between the RD and non-RD patients, the proportions of postoperative bleeding and surgical site infection were significantly higher in the RD patients (5.5% vs 1.8%; P < 0.05, 3.9% vs 1.8%; P < 0.05, respectively), and postoperative bleeding was the highest in the severe CKD group ( P < 0.05). Regardless of the degree of comorbid RD, OS and RFS were comparable, even after PSM between the RD and non-RD groups to exclude the influence of patient characteristics, liver function, and other causes of death. CONCLUSION Comorbid mild RD had a negligible impact on the prognosis of HCC patients who underwent curative hepatectomy with appropriate perioperative management, and close attention to severe CKD is necessary to prevent postoperative bleeding and surgical site infection.

Tips for Preparing and Practicing Thermal Ablation Therapy of Hepatocellular Carcinoma

“…Even if HCC patients complicated with renal failure have a normal platelet count, increased capillary fragility and the disturbance of blood coagulation may result in post-operative hemorrhage. Therefore, close attention to severe CKD is needed to prevent post-operative bleeding [44,45].…”

Perspectives on the Underlying Etiology of HCC and Its Effects on Treatment Outcomes

“…Currently, there are no long-term data regarding HCC risk for the newer first-line HBV medication TAF, though some studies have demonstrated that switching from ETV or TDF to TAF can lead to further increase in virologic response, while preserving renal function. [28][29][30][31][32][33][34][35] Currently, professional society guidelines recommend antiviral treatment for patients without cirrhosis with elevated HBV DNA (≥2000-20,000 IU/mL) and elevated alanine aminotransferase (ALT) levels or fibrosis stage 2 or higher (Table 1) 16,17,[36][37][38] . For patients with cirrhosis especially those with decompensated cirrhosis, antiviral therapy is generally recommended for patients with any level of detectable HBV DNA and irrespective of ALT levels.…”