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

Autor:	Jihye Lim, Ha Il Kim, Eunju Kim, Jiyoon Kim, Jihyun An, Seheon Chang, Seon-Ok Kim, Han chu Lee, Yung Sang Lee, Ju Hyun Shim
Jazyk:	angličtina
Rok vydání:	2021
Předmět:	Hepatocellular carcinoma Portal vein thrombosis Esophageal varices Variceal bleeding Risk factor Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Zdroj:	BMC Cancer, Vol 21, Iss 1, Pp 1-10 (2021)
Druh dokumentu:	article
ISSN:	1471-2407
DOI:	10.1186/s12885-020-07708-1
Popis:	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
Databáze:	Directory of Open Access Journals
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