Variceal bleeding is aggravated by portal venous invasion of hepatocellular carcinoma: a matched nested case-control study.
Variceal bleeding is aggravated by portal venous invasion of hepatocellular carcinoma: a matched nested case-control study.
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DOI：
10.1186/s12885-020-07708-1
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发表时间：
2021-01-05
期刊：
影响因子：
3.8
通讯作者：
Shim JH
中科院分区：
文献类型：
--
作者：
Lim J;Kim HI;Kim E;Kim J;An J;Chang S;Kim SO;Lee HC;Lee YS;Shim JH
我们假设肝细胞癌（HCC）的门静脉癌栓（PVTT）会增加门静脉压力，导致食管静脉曲张和静脉曲张。我们检查了高危静脉曲张和静脉曲张出血的发生率，并确定了静脉曲张筛查和预防的指征。本研究纳入了1709例无症状患者，既往无任何静脉曲张出血或内镜预防病史，在初始抗HCC治疗前或治疗后30天内接受了上消化道内镜检查。在这些患者中，206例有PVTT，经过1：2个体匹配，其中161例与309例无PVTT患者匹配。高危静脉曲张定义为大/中静脉曲张或小静脉曲张伴红色体征和静脉曲张出血。静脉曲张的出血率在配对之间进行比较。还探讨了PVTT患者静脉曲张出血的危险因素。在配对分析中，PVTT组筛选时的高危静脉曲张比例（23.0% vs. 13.3%; P = 0.003）和静脉曲张出血的累积发生率（1年时4.5% vs. 0.4%; P = 0.009）显著更高。在206例PVTT患者中，凝血酶原时间延长、血小板计数降低、存在肝外转移和Vp 4 PVTT是与高危静脉曲张相关的独立危险因素（校正比值比[95% CI]，分别为1.662 [1.151-2.401]; 0.985 [0.978-0.993]; 4.240 [1.783-10.084];和3.345 [1.457-7.680]; Ps < 0.05）。在中位随访43.2个月期间，10例PVTT患者发生静脉曲张出血事件，其中9例（90%）有高危静脉曲张。在完整的PVTT患者组中，存在高危静脉曲张和索拉非尼用于HCC治疗是静脉曲张出血的显著预测因素（校正风险比[95% CI]分别为26.432 [3.230-216.289]和5.676 [1.273-25.300]; Ps < 0.05）。HCC中的PVTT似乎增加了高危静脉曲张和静脉曲张出血的可能性。在HCC伴PVTT患者中，可以考虑内镜预防，至少在服用索拉非尼的高危静脉曲张携带者中。
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. 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. 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). 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.
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影响因子：
3.7
作者：
D'Avola, Delia;Inarrairaegui, Mercedes;Sangro, Bruno
通讯作者：
Sangro, Bruno
DOI：
10.1111/j.1440-1746.2009.05903.x
发表时间：
2009-07-01
影响因子：
4.1
作者：
Hsu, Yao-Chun;Chung, Chen-Shuan;Wang, Hsiu-Po
通讯作者：
Wang, Hsiu-Po
影响因子：
13.5
作者：
Mejias, Marc;Garcia-Pras, Ester;Fernandez, Mercedes
通讯作者：
Fernandez, Mercedes
影响因子：
13.5
作者：
Duffy, Austin;Wilkerson, Julia;Greten, Tim F.
通讯作者：
Greten, Tim F.
影响因子：
12.6
作者：
Giannini, Edoardo Giovanni;Risso, Domenico;Caturelli, Eugenio
通讯作者：
Caturelli, Eugenio