Atrial fibrillation influences survival in patients with hepatocellular carcinoma: Experience from a single center in Taiwan

Background: It is unclear whether atrial fibrillation (AF) adversely influences the clinical course of patients with hepatocellular carcinoma (HCC). Methods: During the period from January 1, 2001 to December 31, 2010, 476 patients (mean±SD age 60.3±12.9years) diagnosed with HCC were retrospectively enrolled in our study. The HCC stage, treatment, baseline characteristics, underlying cardiovascular diseases, and corresponding drug treatment were systematically reviewed. The primary endpoint was death from any cause. Results: AF was associated with a significantly reduced survival time in patients with HCC (AF vs. non-AF patients mean±SD survival time 470.1±89.6days vs. 1161.2±32.6days, log-rank p<0.001 probability of survival 0.20, 95% confidence interval 0.10-0.38, p<0.001). After adjustment for sex and age, AF was still associated with poorer survival times (hazard ratio 4.131, 95% confidence interval 2.134-5.733, p<0.001). The causes of death among 22 patients with both HCC and AF included 11 cases of hepatic failure, four cases of ruptured tumor, and two cases of bleeding from esophageal varices. None of these patients with AF used warfarin. Seven bleeding events related to HCC were noted, but none of these patients developed a major thromboembolism. The mean±SD follow-up period was 645±468days. Conclusion: Patients with HCC had a significantly reduced survival time with the comorbidity of AF. Tumor rupture was relatively common among patients with both HCC and AF. The anticoagulation treatment of AF in patients with HCC deviated from the current guidelines without an increase in thromboembolic events.