Hepatic resection for hepatocellular carcinoma in end-stage renal disease patients: Two decades of experience at Chang Gung Memorial Hospital

Table 1 Demographic data of 1224 HCC patients undergoing hepatectomy with and without ESRD.

	ESRD–HCC (%) (n = 26)	HCC (%) (n = 1198)	P
Age (yr)	53.4±13.2	54.3±13.7	0.748
Gender (M:F)	22:4	937:261	0.433
Associated disease	19 (73.1)	406 (33.9)	0.0001
Symptoms (+)	17 (65.4)	799 (66.7)	0.889
Physical findings (+)	13 (50.0)	289 (24.1)	0.002
HBsAg (+)	11 (42.3)	782/1101 (71.0)	0.002
Anti-HCV Ab (+)	15 (62.5)	314/854 (36.8)	0.01
Dual infection (+)	2/23 (8.7)	99/816 (36.8)	1
Associated cirrhosis (+) child-pugh grade	14 (53.8)	647/1187 (54.5)	0.947
A	19 (76.0)	1014 (89.5)
B+C	6 (24)	119 (10.5)	0.055

M: male; F: female; HBsAg: hepatitis B surface antigen; HCV: hepatitis C virus; Ab: antibody.

Table 2 Associated disease, morbidity, and postoperative mortality of 26 ESRD–HCC and 1198 HCC patients treated with hepatectomy.

	ESRD–HCC (n = 26)		HCC (n = 1198)
Associated disease	19 (73.1%)	Associated disease	406 (33.9%)
ESRD only	7	Peptic ulcer	121
Hypertension	10	DM	111
DM	8	Hypertension	88
Heart disease	3	DM+hypertension	42
TCC	1	DM+peptic ulcer	20
Peptic ulcer	6	Heart disease	31
		CVA	11
		Biliary tract disease	27
		(GB stone or CBD stone or IHD stone
		Lung disease	27
		Others	71
Morbidity	11 (42.3%)	Cause of mortality	66 (5.3%)
Pleural effusion	4	Hepatic failure	12
Ascites	2	Infection-induced hepatic failure	10
Jaundice	1	Intra-abdominal	23
bleeding Pneumonia	1	Cholangititis	1
Intra-abdominal abscess	1	Bile leakage	1
Wound infection	1	ARDS	2
Fever	1	EV bleeding	2
Cause of mortality	3 (11.5%)	Peptic ulcer bleeding	3
Sepsis	2	Combine EV and peptic ulcer bleeding	1
Pulmonary embolism	1	Renal failure	4
		Pneumonia/	1/1
		pulmonary embolism
		VT/heart failure	1/1
		Ischemic bowel	1/1
		/hollow organ perforation
		DIC	1

TCC: transitional cell carcinoma; DM: diabetes mellitus; CVA: cerebrovascular disease; GB: gallbladder; CBD: common bile duct; IHD: intrahepatic duct; ARDS: adult respiratory distress syndrome; EV: esophageal variceal; VT: ventricular tachycardia; DIC: disseminated intravascular coagulopathy.

Table 3 Laboratory data of 1224 HCC patients undergoing hepatectomy with and without ESRD.

	ESRD–HCC (%) (n = 26)	HCC (%) (n = 1198)	P
AFP (ng/mL)	2143.7±10365.5	6520.9±99070.2	0.825
AFP>400 ng/mL	2/25 (8.0)	392/1098 (35.7)	0.003
Hemoglobin (g/dL)	10.6±2.5	13.0±2.1	0.0001
WBC (/µL)	6284.6±3031.0 7	467.6±7956.4	0.449
Platelet (103/µL)	134.7±77.0	179.4±99.2	0.023
PT/PT (normal control)	0.85±1.6	0.96±1.9	0.778
INR (%)	1.10±0.16	1.10±0.18	0.953
Albumin (g/dL)	3.70±0.67	3.90±0.62	0.115
Bilirubin (direct) (mg/dL)	0.30±0.14	0.51±1.16	0.588
Bilirubin (total) (mg/dL)	0.80±0.36	1.12±1.27	0.207
BUN (mg/dL)	54.9±26.9	15.5±7.1	0.0001
Creatinine (mg/dL)	6.64±4.01	1.21±1.69	0.0001
AST (IU/L)	63.5±55.5	72.6±96.0	0.631
ALT (IU/L)	46.6±51.1	63.9±71.0	0.236
ALP (IU/L)	101.5±45.2	114.7±295.6	0.827
ICG 15 (%)	19.4±15.6	14.5±13.9	0.143

AFP: α-fetoprotein; PT: prothrombin time; INR: international normalized ratio; BUN: blood urea nitrogen; AST: aspartate aminotransferase; ALT: alanine aminotransferase; ALP: alkaline phosphatase; ICG 15: indocyanine green retention rate at 15 min.

Table 4 Operative, macroscopic, and microscopic findings of HCC patients with and without ESRD.

	ESRD–HCC (%) (n = 26)	HCC (%) (n = 1198)	P
Major hepatectomy	17/26 (65.4)	603/1198 (50.3)	0.129
Blood loss (cc)	955.8±771.2	1358.6±1593.3	0.199
Blood transfusion (cc)	462.0±580.1	1037.9±2261.9	0.204
Tumor size (cm)	4.1±2.0	6.2±4.5	0.0001
Tumor size >5 cm	6/26 (23.1)	545/1171 (46.5)	0.018
Grading (Edmondson and Stainer)
Low-grade (I+II)	10/25 (40.0)	504/948 (53.2)
High-grade (III+IV)	15/25 (60.0)	444/948 (46.8)	0.193
Capsule formation (+)	16/21 (76.2)	676/1012 (66.8)	0.365
Capsule invasion (+)	8/15 (53.3)	359/625 (57.4)	0.751
Macroscopic vascular invasion (+)	8/24 (33.3)	431/1150 (37.5)	0.678
Satellite lesions (+)	5/25 (20.0)	336/1155 (29.1)	0.321
Resection margin >1 cm	12/23 (52.2)	373/1051 (35.5)	0.099
Rupture (+)	3/26 (11.5)	140/1167 (12.0)	0.943
Complication	11/26 (42.3)	240/1198 (20.0)	0.005
Hospital stay (d)	26.8±11.7	21.7± 12.7	0.046
Mortality	3/26 (11.5)	63/1198 (5.3)	0.161

Table 5 Univariate and multiple forward stepwise logistic regression analysis of clinicopathological features in 1224 HCC patients after hepatectomy between ESRD and non-ESRD groups.

	Univariate analysis P	Multivariate logisticregression analysis P
Associate disease	0.001	NS
Presence of physical findings	0.002	NS
Positive HBsAg	0.002	NS
Positive anti-HCV Ab	0.002	NS
Platelet<150 000/mL	0.011	NS
Hb<10 g/dL	0.0001	NS
BUN>30 mg/dL	0.0001	0.0001
Cr>1.5 mg/dL	0.0001	0.002
AFP>400 ng/L	0.003	NS
Tumor size<5 cm	0.018	NS
Hospital stay>21 d	0.035	NS
Complication	0.005	NS

HBsAg: hepatitis B surface antigen; HCV: hepatitis C virus; Ab: antibody; Hb: hemoglobin; BUN: blood urea nitrogen; Cr: creatinine; AFP: α-fetoprotein.

Table 6 Prognosis of HCC patients undergoing hepatectomy with and without ESRD.

	ESRD–HCC (%)	HCC (%)	P
Overall survival (mo)
mean	47.9	63.3
Median	23.6	32.8
95%CI of mean	27.3; 68.4	55.7; 71.0
Log-rank			0.7034
DFS (mo)
mean	35.9	52.0
Median	14.8	15.5
95%CI of mean	17.0; 54.7	43.7; 60.3
Log-rank			0.6123

CI: confidence interval; DFS: disease-free survival.