Development of hepatocellular carcinoma after successful management of esophageal variceal bleeding.

BACKGROUND: Endoscopic and pharmacological treatments significantly reduce recurrent esophageal variceal bleeding and improve the prognosis of cirrhotic patients. This study was aimed to evaluate the incidence, risk factors, treatment and prognosis of hepatocellular carcinoma after esophageal variceal bleeding.

METHODS: Patients with esophageal variceal bleeding underwent endoscopic or pharmacological treatments to arrest acute bleeding or prevent rebleeding. Concurrently, patients were followed by periodic serum alpha-fetoprotein examinations and ultrasonography, aiming at early detection and possible treatment of hepatocellular carcinoma.

RESULTS: Hepatocellular carcinoma developed in 79 of 370 patients (21.4%) during the 10-year follow-up. The cumulative incidence of hepatocellular carcinoma was 21.1% at the end of the third year, 39.3% at the end of the fifth year and 53.0% at the end of the tenth year. Small tumors (< or = 3 cm) were found in 64 patients (81.0%, monofocal tumors in 46 patients). Age, hepatitis B virus, hepatitis C virus, and alpha-fetoprotein level > 20 ng/mL were factors associated with the risk of hepatocellular carcinoma development by multivariate analysis using Cox regression. Tumors were actively treated in 37 of 49 Child-Pugh A and B patients (75.5%) and 2 of 30 Child-Pugh C patients (6.7%). The median survival of all patients was 2.5 (range, 0.5 to 10.0) years. Development of hepatocellular carcinoma and serum bilirubin level were significantly associated with mortality in Child-Pugh A and B patients.

CONCLUSIONS: Patients with esophageal variceal bleeding had a high risk of developing hepatocellular carcinoma. Surveillance on hepatocellular carcinoma could detect most tumors with small size. Hepatocellular carcinoma had an adverse impact on the survival of patients without advanced cirrhosis.