Variceal bleeding is aggravated by portal venous invasion of hepatocellular carcinoma: a matched nested case-control study

BMC Cancer

Seon-Ok Kim¹  Jihye Lim²  Han chu Lee²  Yung Sang Lee²  Jiyoon Kim²  Ju Hyun Shim²  Eunju Kim³  Jihyun An⁴  Ha Il Kim⁵  Seheon Chang⁶ 

[1] Biostatistics and Clinical Epidemiology, Asan Medical Center, University of Ulsan College of Medicine;Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine;Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University;Gastroenterology, Hanyang University College of Medicine;Gastroenterology, Kyung Hee University Hospital;Internal Medicine, Myongji St. Mary’s Hospital;

关键词: Hepatocellular carcinoma;    Portal vein thrombosis;    Esophageal varices;    Variceal bleeding;    Risk factor;   

DOI  :  10.1186/s12885-020-07708-1

来源: DOAJ

【 摘 要 】

Abstract Background We hypothesized that portal vein tumor thrombosis (PVTT) in hepatocellular carcinoma (HCC) increases portal pressure and causes esophageal varices and variceal bleedings. We examined the incidence of high-risk varices and variceal bleeding and determined the indications for variceal screening and prophylaxis. Methods This study included 1709 asymptomatic patients without any prior history of variceal hemorrhage or endoscopic prophylaxis who underwent upper endoscopy within 30 days before or after initial anti-HCC treatment. Of these patients, 206 had PVTT, and after 1:2 individual matching, 161 of them were matched with 309 patients without PVTT. High-risk varices were defined as large/medium varices or small varices with red-color signs and variceal bleeding. Bleeding rates from the varices were compared between matched pairs. Risk factors for variceal bleeding in the entire set of patients with PVTT were also explored. Results In the matched-pair analysis, the proportion of high-risk varices at screening (23.0% vs. 13.3%; P = 0.003) and the cumulative rate of variceal bleeding (4.5% vs. 0.4% at 1 year; P = 0.009) were significantly greater in the PVTT group. Prolonged prothrombin time, lower platelet count, presence of extrahepatic metastasis, and Vp4 PVTT were independent risk factors related to high-risk varices in the total set of 206 patients with PVTT (Adjusted odds ratios [95% CIs], 1.662 [1.151–2.401]; 0.985 [0.978–0.993]; 4.240 [1.783–10.084]; and 3.345 [1.457–7.680], respectively; Ps < 0.05). During a median follow-up of 43.2 months, 10 patients with PVTT experienced variceal bleeding episodes, 9 of whom (90%) had high-risk varices. Presence of high-risk varices and sorafenib use for HCC treatment were significant predictors of variceal bleeding in the complete set of patients with PVTT (Adjusted hazard ratios [95% CIs], 26.432 [3.230–216.289]; and 5.676 [1.273–25.300], respectively; Ps < 0.05). Conclusions PVTT in HCC appears to increase the likelihood of high-risk varices and variceal bleeding. In HCC patients with PVTT, endoscopic prevention could be considered, at least in high-risk variceal carriers taking sorafenib.

【 授权许可】

Unknown