Macrovascular Malignant Portal Vein Thrombosis in Cirrhotic Patients with HCC

Shabana, Hany R.

doi:10.15406/ghoa.2016.05.00127

Cited by 3 publications

(9 citation statements)

References 8 publications

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“… Kaplan-Meier Analysis Univariate Cox regression Median Survival time (months) (95% C.I.) Log-Rank p-value HR a (95% CI) HR p-value # Tumor Nodules ≤2 11 [ [9] , [10] , [11] , [12] , [13] ] <0.0001 Reference >2 6 [ [5] , [6] , [7] ] 1.56 (1.38–1.77) <0.001 Albumin (g/dL) ≥3.5 13 [ [11] , [12] , [13] , [14] , [15] , [16] ] <0.0001 Reference <3.5 7 [ 6 , 7 ] 1.54 (1.35–1.75) <0.001 CRP (mg/L) ≤10 6 [ [4] , [5] , [6] , [7] , [8] ] 0.46 Reference ...…”

Section: Resultsmentioning

confidence: 99%

“… <0.0001 Reference # Nodules (≤2) & Albumin (<3.5) b 477 8 mo [ [7] , [8] , [9] ]. 1.58 (1.33–1.86) <0.001 # Nodules (>2) & Albumin (≥3.5) b 152 8 mo [ [6] , [7] , [8] , [9] , [10] , [11] , [12] ]. 1.65 (1.32–2.06) <0.001 # Nodules (>2) & Albumin (<3.5) c 278 5 mo [ [4] , [5] , [6] ].…”

Section: Resultsunclassified

“… Log-Rank p-value HR ∗ (95% CI) HR p-value Combination Nodule # & serum Albumin (g/dL) Nodule # (≤2) & Albumin (≥3.5) a 139 21 mo [ [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] ]. <0.0001 Reference Nodule # (≤2) & Albumin (<3.5) b 186 9 mo [ [8] , [9] , [10] , [11] , [12] , [13] ]. 1.56 (1.20–2.02) 0.001 Nodule # (>2) & Albumin (≥3.5) b 50 12 mo [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] ].…”

Section: Resultsunclassified

“… <0.0001 Reference Nodule # (≤2) & Albumin (<3.5) b 186 9 mo [ [8] , [9] , [10] , [11] , [12] , [13] ]. 1.56 (1.20–2.02) 0.001 Nodule # (>2) & Albumin (≥3.5) b 50 12 mo [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] ]. 1.48 (1.02–2.15) 0.04 Nodule # (>2) & Albumin (<3.5) c 73 5 mo [ [4] , [5] , [6] , [7] ].…”

Section: Resultsunclassified

“…The 2 parameters were identified by KM and Cox regression analysis of clinical parameters that significantly related to survival in PVT patients. We had supposed from earlier literature that serum AFP levels would be important [ 11 ]. However, only 57.7% of the PVT cohort had elevated AFP levels.…”

Section: Discussionmentioning

confidence: 99%

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Tumor multifocality and serum albumin levels can identify groups of patients with hepatocellular carcinoma and portal vein thrombosis having distinct survival outcomes

Carr

Guerra

Donghia

et al. 2021

Annals of Medicine &Amp; Surgery

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Background Macroscopic portal vein thrombosis (PVT) is a major poor prognosis factor in patients with hepatocellular carcinoma (HCC), but constitute a heterogeneous group. Aims To examine blood and tumor parameters of 1667 HCC patients who had PVT to identify factors that could differentiate different survival subsets. Methods a large HCC database was examined for presence of patients with PVT and analyzed retrospectively for PVT-associated factors and prognosis. Results A logistic regression model was calculated for presence of PVT. Highest odds ratios were found for tumor multifocality and serum albumin levels, as well as serum alpha-fetoprotein (AFP) and bilirubin levels. A Kaplan-Meier and Cox model on survival also showed the highest hazard ratios for tumor multifocality and serum albumin. A model was constructed on all 4 possible combinations of tumor focality and serum albumin in PVT patients. The longest survival group had <2 tumor nodules plus serum albumin >3.5 g/dL. Conversely, the shortest survival group had >2 tumor nodules plus serum albumin <3.5 g/dL. These 2 patient groups differed in maximum tumor diameter and levels of serum AFP, AST and bilirubin. Conclusions Combination low tumor focality and high serum albumin identifies prognostically better PVT patient subgroups that might benefit from aggressive therapies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsunclassified

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Tumor multifocality and serum albumin levels can identify groups of patients with hepatocellular carcinoma and portal vein thrombosis having distinct survival outcomes

Carr

Guerra

Donghia

et al. 2021

Annals of Medicine &Amp; Surgery

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The role of shear wave elastography in differentiation between benign and malignant portal vein thrombosis in hepatocellular carcinoma

Ahmad

Elsawy

Omar

et al. 2022

Egypt J Radiol Nucl Med

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Background Hepatocellular carcinomas (HCC) most commonly complicate liver cirrhosis and it may coexist with malignant portal vein invasion (PVI) that minimizes its possible treatment opportunities and negatively affects its prognosis. However, liver cirrhosis may also be associated with non-tumoral portal vein thrombosis (PVT) particularly in decompensated cirrhosis. Thus, discrimination between tumoral and non-tumoral PVT most preferably by non-invasive imaging techniques is mandatory before treatment decision. Based on the concept of changing tissue elasticity according to tissue pathological changes, Shear wave elastography (SWE) could quantitatively assess tissue stiffness in malignant PVI. We aimed in this work to evaluate the performance of SWE as a novel fast non-invasive diagnostic modality for malignant PVI in cirrhotic patients with HCC. Results Seventy-eight HCC patients with PVT included in this prospective cross-sectional study, tumoral and non-tumoral PVT were differentiated using triphasic CT and/or dynamic MRI, then SWE was blindly and independently done for all included patients. non-tumoral PVT was present in 21.8% of our HCC patients mostly in decompensated cirrhosis. All of our evaluated predictor factors were evaluated by univariate logistic regression analysis to identify the significant factors in prediction of malignant PVI (SWE, AFP, HCC size, HCC multi-focality, and PVD). By using the multivariate logistic regression we identified that the most independent significant factors were SWE and PVD (sig.: 0.012 and 0.045 respectively). SWE was evaluated versus the criteria of PVT and we found that malignant PVI has significant higher SWE values than benign non-tumoral PVT (sig: 0.012). Two cutoff values were calculated for SWE using ROC curve; the 1st cutoff point was selected to rule in malignant PVI for values ≥ 13 kps, while the 2nd cutoff point was selected to rule out malignant PVI for values ≤ 9 kps with a significant discriminatory performance (AUC: 0.984; sig: 0.000). Conclusions SWE could be used as a novel fast and non-invasive indicator of malignant portal vein invasion in cirrhotic patients with HCC especially for values ≥ 13 kps and particularly if coexists with larger values of PVD and AFP.

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Portal vein thrombosis in patients with hepatocellular carcinoma and early cirrhosis – prevalence and risk factors

Siddiqui¹,

Fareed²,

Khan³

et al. 2023

ecancer

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Introduction Hepatocellular carcinoma (HCC) is frequently associated with portal vein thrombosis (PVT) with prevalence ranging from 25% to 50%. PVT is associated with poor prognosis, limiting the available therapeutic options for these patients. Our objective was to determine the prevalence and risk factors for PVT in patients with HCC. Method A retrospective analysis was performed on the prospectively collected data from January 2018 to March 2020. All patients with HCC discussed in our weekly multidisciplinary liver clinic were reviewed. Multivariate analysis was done to identify the independent risk factors for PVT in HCC patients. A p -value of <0.05 was considered significant. Result Of 316 patients, the prevalence of PVT was 31% ( n = 98). Larger tumour size ( p < 0.001), raised Alpha Fetoprotein (AFP) level ( p = 0.036) and higher Child–Pugh class ( p = 0.008) were significantly associated with PVT. In 216 patients with preserved liver function (Child–Pugh class A), PVT was seen in 53 (24.5%) patients. Large tumour size ( p < 0.001) and higher AFP levels ( p = 0.021) were independent risk factors. Conclusion Overall prevalence of PVT in HCC was 31% whereas 24.5% in patients with early cirrhosis (Child–Pugh class A). We identified various risk factors associated with PVT in our local population, highlighting the importance of early and regular screening of cirrhotic patients including Child–Pugh class A.

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Macrovascular Malignant Portal Vein Thrombosis in Cirrhotic Patients with HCC

Cited by 3 publications

References 8 publications

Tumor multifocality and serum albumin levels can identify groups of patients with hepatocellular carcinoma and portal vein thrombosis having distinct survival outcomes

Tumor multifocality and serum albumin levels can identify groups of patients with hepatocellular carcinoma and portal vein thrombosis having distinct survival outcomes

The role of shear wave elastography in differentiation between benign and malignant portal vein thrombosis in hepatocellular carcinoma

Portal vein thrombosis in patients with hepatocellular carcinoma and early cirrhosis – prevalence and risk factors

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