Prognosis of hepatocellular carcinoma in hemodialysis patients with radiofrequency ablation

 

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Prognosis of hepatocellular carcinoma in hemodialysis patients with radiofrequency ablation

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Yoshiyasu
Ogura
Yoshiyasu Ogura yoshiyasuogu@gmail.com Mitsui Memorial Hospital Department of Nephrology Tokyo Japan *
Takamasa Ohki lily.rover220@gmail.com Mitsui Memorial Hospital Department of Nephrology Tokyo Japan -
Naobumi Mise misenn@mitsuihosp.or.jp Mitsui Memorial Hospital Department of Nephrology Tokyo Japan -
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The aim of this study was to compare the prognosis of hepatocellular carcinoma (HCC) between dialysis and non-dialysis patients with radiofrequency ablation (RFA).

In this retrospective observational study, we examined consecutive patients with naïve localized HCC, who were treated with RFA between February 2000 and December 2021. The patients were categorized into two subgroups based on whether they were on maintenance dialysis (Dialysis Group, n=32) or not (Non-dialysis Group, n=537), and were followed until December 2023. The primary endpoint was overall survival using Kaplan-Meier analysis. As for propensity score matching, we matched 1:2 pairs of cases by using age, sex, Child-Pugh score, tumor size, number of tumors and HCV positivity. We also compared causes of death and the rate of major complications of first RFA between the 2 groups.

The study cohort were aged 70.7±9.4 years and included 399 male patients (70%). Hepatitis B was positive in 47 patients (8.3%), C in 365 (64.1%) and co-infection of HBV and HCV was detected in 4 patients (0.7%). One hundred and thirty-six (23.9%) were heavy alcohol drinkers. In the entire cohort, overall survival was comparable between Dialysis Group and Non-dialysis Group. (5-year survival rate 73.1% vs 55.3%, respectively; p =0.27). In the 1:2 propensity score matching analysis, overall survival in Dialysis Group was also comparable to that in Non-dialysis Group (5-year survival rate 73.1% vs 64.9%, respectively; p =0.94) (Figure 1.). During the observational period, 313 (55.0%) patients died. As for causes of death, liver-disease-related death occurred in 42.1% in Dialysis Group and 63.3% in Non-dialysis Group, whereas cardiovascular death occurred in 10.5% in Dialysis Group and 1.4% in Non-dialysis Group. Procedure-related major complication in the first RFA session of each patient was observed in 2 (6.3%) in Dialysis Group and 13 (2.4%) in Non-dialysis Group.

Prognosis of HCC was comparable in dialysis and non-dialysis patients, but liver-disease-related death was less frequent in dialysis population. Since RFA has been safely preformed in dialysis patients, prognostic improvement may be expected by treating HCC in dialysis patients as proactively as in non-dialysis cases.

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