Comparison of prognoses between cirrhotic and noncirrhotic patients with hepatocellular carcinoma and esophageal varices undergoing surgical resection

Sep 29, 2026

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Background: Esophageal varices (EV) are common and a poor prognostic feature in hepatocellular carcinoma (HCC), yet outcomes between cirrhotic and noncirrhotic HCC patients with EV remain insufficiently characterized. Methods: This retrospective study included 111 HCC patients with EV undergoing surgical resection from July 2003 to July 2019. Cirrhosis was defined by Ishak fibrosis score F5–F6. Prognostic factors were evaluated using Cox models. Results and conclusion: Cirrhosis increased posthepatectomy decompensation risk, but did not worsen overall survival or recurrence-free survival.

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Abstract

Background

Methods

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1. Introduction

. J Chin MedAssoc Original article Comparison of prognoses between cirrhotic and noncirrhotic patients with hepatocellular carcinoma and esophageal varices undergoing surgical resection Yu-Jen Chena, Chien-Wei Sua,b,c,d,h, Cheng-Yi Weia,b, Gar-Yang Chaub,e, Ping-Hsien Chenb,f, Yee Chaob,g, Yi-Hsiang Huanga,h, Jaw-Ching Wuh, Tsung-Chieh Yanga,b, Pei-Chang Leea,b, Ming-Chih Houa,b,* aDivision of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bSchool of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cHospitalist Ward, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; dBiomedical Science and Engineering Center, National Tsing Hua University, Hsinchu, Taiwan, ROC; eDivision of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; fDivsion of Gastroenterology and Hepatology, Department of Medicine, West Garden Hospital, Taipei, Taiwan, ROC; gDepartment of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; hInstitute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC Abstract Background: Esophageal varices (EV) is common and is a poor prognostic factor for patients with hepatocellular carcinoma (HCC) . However, the outcomes between cirrhotic and noncirrhotic HCC patients with EV is not well studied. The present study aimed to investigate the clinical manifestations and prognoses of HCC patients after surgical resection stratified by the cirrhosis status. Methods: A total of 111 patients with HCC and EV, who underwent surgical resection, were retrospectively enrolled between July 2003 and July 2019. The diagnosis of liver cirrhosis was established using the Ishak fibrosis score F5 or F6 in the nontumor part of liver specimens. Prognostic factors were analyzed using the Cox proportional hazards model. Results: There were 85 (76 .6%) and 26 (23 .4%) patients with and without cirrhosis, respectively. Compared with those without cirrhosis, there were more females, less seropositive rate of hepatitis B surface antigen (HBsAg), more seropositive rate of antibody against to hepatitis C virus (HCV), less albumin-bilirubin (ALBI) grade 1, lower platelet count, and more had tumor burden within the Milan criteria in cirrhotic patients. Cirrhotic patients had a higher risk of posthepatectomy decompensation compared to noncirrhotic patients (hazard ratio 9 .577, p = 0 .017) . No difference was observed in overall survival and recurrence-free survival between patients with or without cirrhosis. Conclusion: Compared with patients without cirrhosis, cirrhotic patients with HCC and EV are vulnerable to posthepatectomy decompensation. However, cirrhosis is not a poor prognostic factor of overall survival and recurrence for HCC patients after surgical resection. Keywords: Esophageal varices; Noncirrhotic hepatocellular carcinoma; Posthepatectomy decompensation 1. INTRODUCTION Hepatocellular carcinoma (HCC) is the major cause of the primary liver cancers, and it is the second leading cause of cancer *Address correspondence: Dr. Ming-Chih Hou, Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: mchou@vghtpe.gov.tw](ROC. E-mail address: mchou@vghtpe.gov.tw)[ ](ROC. E-mail address: mchou@vghtpe.gov.tw)(M.-C. Hou). Conflicts of interest. Dr. Yee Chao, Dr. Yi-Hsiang Huang and Dr. Ming-Chih Hou, editorial board members at Journal of the Chinese Medical Association, have no roles in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2022) 85: 679-686. Received January 4, 2022

FAQs

How was cirrhosis defined in this study?

Cirrhosis was established using the Ishak fibrosis score F5 or F6 in the non-tumor portion of liver specimens.

Does cirrhosis increase posthepatectomy decompensation risk for HCC patients with EV?

Yes. Cirrhotic patients had a higher risk of posthepatectomy decompensation compared with noncirrhotic patients (hazard ratio 9.577, p=0.017).

Is cirrhosis associated with worse survival or recurrence after surgical resection?

No. Overall survival and recurrence-free survival were not significantly different between patients with and without cirrhosis.

Sep 29, 2026

Uploaded by Kyle