Pre-operative anaemia - common and prognostic for hepatocellular carcinoma treated by hepatectomy

Abstract

OBJECTIVE: Hepatocellular carcinoma is one of the commonest cancer while liver resection is the main curative treatment for hepatocellular carcinoma. At the same time, anaemia is common in cancer patients. Although the prognostic value of anaemia was shown in other cancers, its role in hepatocellular carcinoma was not clear. We evaluated the prevalence of anaemia in patients underwent hepatectomy and the prognostic value of anaemia for these patients. METHODS: The study included 488 patients who underwent liver resection for hepatocellular carcinoma with curative intent between 2002 and 2012. Pre-operative investigation performed on the first consultation were reviewed while anaemia was defined as haemoglobin <13.3 g/dl for man and <11.5 g/dl for women according to our haematology laboratory. Survival analysis were performed and prognostic factors were identified with cox-proportional hazard models. RESULTS: The anaemic group consisted of 122 patients while the normal group consisted of 362 patients. The overall median survival for the anaemic group was shorter (53 months vs. 98 months, p = 0.002). And the disease free survival for the anaemic group was also poorer (p = 0.016). In multivariable analysis, anaemia was adjusted and AFP >400 ng/ml, blood transfusion, multiple tumours, macrovascular invasion, adjacent organ invasion and microvascular invasion were independent predictive factor for survival. CONCLUSION: The current study showed that 25% of hepatectomy candidates had pre-operative anaemia. Anaemia is associated with poorer long term survival with RR 1.48, 95% CI 1.12–1.97, p = 0.007.