Jaundice, fluid retention in HCC tied to shorter survival

The presence of jaundice or fluid retention among patients with hepatocellular carcinoma (HCC) is associated with a shorter overall survival (OS), suggests a Singapore study. 

“This can serve as a tool for early prognostication and allow timely decisions for further investigations and treatment, especially in situations where medical resources are limited,” the researchers said. 

Overall, 725 patients with symptomatic HCC seen at a single institution since October 1983 were included in the study cohort. An additional 545 patients were diagnosed on surveillance or from incidental findings. Researchers documented the presenting symptoms at diagnosis and carried out a survival census on 31 October 2015 with the national registry of deaths. 

Multivariable Cox regression analysis was conducted to explore the associations between presenting symptoms and OS. The research team also performed a survival analysis using Kaplan–Meier method with log-rank testing and used bivariate Pearson correlation to examine any link between duration of symptoms and OS. 

Survival was significantly shorter among patients with symptomatic HCC than those diagnosed incidentally or on screening (94.0 vs 786.0 days; p<0.001), particularly in patients presenting with fluid retention (56.0 vs 118.0 days; p<0.001), jaundice (48.0 vs 94.0 days; p=0.017), and two or more symptoms (p=0.010). [Singapore Med J 2024;65:444-448] 

Notably, pain was predictive of better survival (p<0.001). Multivariate analysis revealed that only fluid retention (hazard ratio [HR], 1.56, 95 percent confidence interval [CI], 1.30–1.87) and jaundice (HR, 1.36, 95 percent CI, 1.071.74) independently correlated with shorter OS. No significant association was seen between symptoms duration and OS. 

“Early prognostication and subsequent alignment of expectations allow patients to address end-of-life issues in a timely manner, and this is all the more crucial when the expected survival is short,” the researchers said. “In our study, patients with symptomatic HCC had a short median OS of 3 months from the time of diagnosis.” 

In an earlier study, majority of the patients with advanced gastrointestinal cancers (>80 percent) believed that it was “highly important” to know about their prognosis and that those with a better understanding of their condition were more likely to have realistic goals of care. [Cancer 2014;120:278-285] 

“This helps clinicians and patients mutually agree on the need and urgency for further investigations and treatment,” the researchers said. 

A study in Italy involving 1,051 patients found significantly shorter OS in those with symptomatic versus asymptomatic HCC (14 vs 36 months). Another study of 306 patients in Hong Kong also observed shorter OS among those with symptomatic HCC compared with patients diagnosed on screening (5 vs 22 months). [Am J Gastroenterol 2002;97:734-744; Hepatology 2000;31:330-335] 

The present study showed similar statistics. “We hope that our findings can help to shed new light on this area and allow it to serve as a tool for early prognostication,” the researchers said. “It can also be useful in situations where medical resources are limited, since the prognostication models for HCC necessitate biochemical investigations and cross-sectional imaging.”