Development of a risk score to predict portal vein tumor thrombosis in patients with hepatocellular carcinoma

Abstract

Background Portal vein tumor thrombosis (PVTT) is a common complication of hepatocellular carcinoma and is one of the most negative prognostic factors. The management of patients with PVTT is challenging. The aim of the study was to develop a score predictive of tumor thrombosis. Methods Data from a large cohort of 2243 hepatocellular carcinoma patients (all stages) recorded in the Progetto Epatocarcinoma Campania (January 2013–April 2021) database were analyzed. To construct the score, univariate generalized estimated equation models, the bootstrap approach for internal validation, and a regression coefficient-based scoring system were used. Results PVTT (any location) was found in 14.4% of cases and was related to shorter survival. Males, younger patients, and symptomatic cases were more prevalent among the PVTT group. At multivariate analysis, size ≥5 cm, massive or infiltrative hepatocellular carcinoma growth, and alpha-fetoprotein ≥400 ng/mL were significantly associated with PVTT. A risk prediction score of PVTT based on eight variables was developed. Using a continuous score, the risk was associated with an odds ratio (OR) of 1.30 (1.27–1.34; P < 0.001). Considering a dichotomous score >8 versus a score ≤8 the OR for PVTT was 11.33 (8.55–15.00; P < 0.001). Conclusion The risk score for PVTT might be useful for clinicians to optimize hepatocellular carcinoma management by picking out patients with more aggressive cancers and higher mortality rates. Prospective validation of the score is needed before its application in daily clinical practice.

Pretreatment Non-Invasive Biomarkers as Predictors to Estimate Portal Vein Tumor Thrombosis (PVTT) Risk and Long-Term Survival in HBV-Related Hepatocellular Carcinoma Patients Without PVTT

“…In our study, we observed that a total of 136 patients (13.3%) experienced PVTT events during the follow-up period, which was mostly in line with the results reported by Guarino et al (11.1%) and Tortora et al (14.4%). 24 , 25 …”

“…In our study, we observed that a total of 136 patients (13.3%) experienced PVTT events during the follow-up period, which was mostly in line with the results reported by Guarino et al (11.1%) and Tortora et al (14.4%). 24,25 Multivariate Cox regression analysis revealed that male gender, AAPR ≤0.49, APRI >0.48, the presence of extrahepatic metastasis, and multiple tumors were independent risk factors for PVTT. We suggest that patients with a high risk of PVTT progression should be followed up regularly and closely.…”

Research Progress in Predicting Hepatocellular Carcinoma with Portal Vein Tumour Thrombus in the Era of Artificial Intelligence

“…Portal vein tumor thrombosis, the predominant type of macrovascular invasion, is present in approximately 10–40% of individuals diagnosed with HCC. 44 Its occurrence typically signifies accelerated disease advancement and is associated with intrahepatic and extrahepatic metastasis, portal hypertension, hepatocellular jaundice, and refractory ascites. Consequently, the ability to anticipate the development of PVTT in patients and implement timely interventions to postpone or mitigate its effects is imperative.…”