Summative Comorbidities Are Independently Associated With Mortality in Patients With Hepatocellular Carcinoma

BACKGROUND: Comorbidities might limit therapeutic options and negatively impact survival in patients with hepatocellular carcinoma (HCC). The Charlson Comorbidity Index (CCI) is widely used to summarize and quantify comorbidities. METHODS: HCC patients diagnosed between 1992 and 2018 at the Medical University of Vienna were retrospectively analysed. A modified CCI (mCCI), assigning no points for liver disease and HCC, was used to quantify comorbidities. The association of mCCI with clinical characteristics, overall survival (OS) and liver-related survival (LrS) was analysed. RESULTS: Of 1359 evaluable patients, 628 (46.2%) had no relevant comorbidities (mCCI = 0 points), 626 (46.1%) had 1-2 points in the mCCI and 105 (7.7%) had ≥ 3 points. Mean age at diagnosis was 63.7 years (standard deviation ±10.1 years) and 1124 patients (82.7%) were male. In multivariable analysis, mCCI as a categorial (adjusted hazard ratio [aHR] for 1-2 points 1.20, 95% confidence interval [CI] 1.04-1.38; aHR for ≥ 3 points 1.58, 95% CI 1.22-2.04; p < 0.001) and continuous variable (aHR 1.13, 95% CI 1.06-1.20; p < 0.001) was independently associated with OS. Similarly, mCCI was a significant independent predictor of LrS, both as categorial (aHR for 1-2 points 1.19, 95% CI 0.95-1.50; aHR for ≥ 3 points 1.64, 95% CI 1.11-2.43; p = 0.031) and as continuous variable (aHR 1.11, 95% CI 1.02-1.22; p = 0.023). CONCLUSIONS: The mCCI was significantly associated with OS and LrS, independent from established risk factors such as liver function and tumour extent. Whether comorbidities should be integrated into therapeutic algorithms in HCC warrants prospective evaluation.