title: Primary Prophylaxis for Variceal Bleeding and the Improved Survival of Patients with Newly Diagnosed Hepatocellular Carcinoma.
abstract: We evaluated the impact of primary variceal bleeding prophylaxis on long-term outcomes of patients newly diagnosed with hepatocellular carcinoma (HCC).
  
  
  
  A retrospective cohort of 898 patients newly diagnosed with HCC without a history of variceal bleeding [age 57.4 ± 10.4, males 718 (80.0 %)] were analyzed for new onset variceal bleeding during follow-up.
  
  
  
  Variceal bleeding occurred in 72 patients (8.0 %) during follow-up. The presence of portal vein thrombosis [hazard ratio (HR) 3.90; 95 % confidence interval (CI) 2.09-7.30; p < 0.001] and the presence of the red color sign or ≥grade 2 varices at index endoscopy (HR 7.64; 95 % CI 4.56-12.80; p < 0.001) were independent risk factors for variceal bleeding. The occurrence of variceal bleeding was an independent risk factor for mortality (HR 1.39; 95 % CI 1.06-1.82; p = 0.015). The cumulative incidence rate of variceal bleeding at 1 year was 2.1, 15.3, and 34.2 % for those non-indicated for primary prophylaxis (n = 760), indicated for primary prophylaxis and received prophylaxis (n = 98), and indicated for primary prophylaxis but did not received prophylaxis (n = 40) (p < 0.001). Primary prophylaxis for variceal bleeding for indicated patients was associated with a reduced risk of mortality in all patients (HR 0.54; 95 % CI 0.33-0.88; p = 0.014) and in propensity-matched patients (HR, 0.54; 95 % CI 0.31-0.95; p = 0.033).
  
  
  
  Variceal bleeding was independent risk factor for survival of newly diagnosed HCC patients. Screening and providing primary prophylaxis for indicated patients should be considered for patients with HCC.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351, 81 Irwon-ro, Gangnam-gu, Seoul, Korea.
authors.forename: Jung Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351, 81 Irwon-ro, Gangnam-gu, Seoul, Korea. dh.sinn@samsung.com.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Sinn
authors.affiliation: Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea.
authors.forename: Kyunga
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351, 81 Irwon-ro, Gangnam-gu, Seoul, Korea.
authors.forename: Wonseok
authors.initials: W
authors.lastname: Kang
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351, 81 Irwon-ro, Gangnam-gu, Seoul, Korea.
authors.forename: Geum-Youn
authors.initials: GY
authors.lastname: Gwak
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351, 81 Irwon-ro, Gangnam-gu, Seoul, Korea.
authors.forename: Yong-Han
authors.initials: YH
authors.lastname: Paik
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351, 81 Irwon-ro, Gangnam-gu, Seoul, Korea.
authors.forename: Moon Seok
authors.initials: MS
authors.lastname: Choi
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351, 81 Irwon-ro, Gangnam-gu, Seoul, Korea.
authors.forename: Joon Hyeok
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351, 81 Irwon-ro, Gangnam-gu, Seoul, Korea.
authors.forename: Kwang Cheol
authors.initials: KC
authors.lastname: Koh
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351, 81 Irwon-ro, Gangnam-gu, Seoul, Korea.
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Paik
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000628:therapy*; D015331:Cohort Studies; D016145:Endoscopy, Digestive System / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008026:Ligation / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Bleeding; Hepatocellular carcinoma; Prevention; Survival; Varix