肝细胞癌门静脉侵犯会加重静脉曲张出血：一项配对巢式病例对照研究。

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

作者信息

Lim Jihye, Kim Ha Il, Kim Eunju, Kim Jiyoon, An Jihyun, Chang Seheon, Kim Seon-Ok, Lee Han Chu, Lee Yung Sang, Shim Ju Hyun

机构信息

Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.

Gastroenterology, Kyung Hee University Hospital, Seoul, Republic of Korea.

出版信息

BMC Cancer. 2021 Jan 5;21(1):11. doi: 10.1186/s12885-020-07708-1.

DOI:10.1186/s12885-020-07708-1

PMID:33402105

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7786454/

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.

摘要

背景

我们推测肝细胞癌（HCC）中的门静脉肿瘤血栓形成（PVTT）会增加门静脉压力，并导致食管静脉曲张和曲张静脉出血。我们研究了高危静脉曲张和曲张静脉出血的发生率，并确定了曲张静脉筛查和预防的指征。

方法

本研究纳入了1709例无症状患者，这些患者既往无曲张静脉出血或内镜下预防史，在初始抗HCC治疗前或后30天内接受了上消化道内镜检查。其中，206例患者有PVTT，经过1:2个体匹配后，其中161例与309例无PVTT的患者匹配。高危静脉曲张定义为大/中型静脉曲张或伴有红色征的小型静脉曲张以及曲张静脉出血。比较匹配对之间曲张静脉的出血率。还探讨了整个PVTT患者组中曲张静脉出血的危险因素。

结果

在配对分析中，PVTT组筛查时高危静脉曲张的比例（23.0%对13.3%；P = 0.003）和曲张静脉出血的累积发生率（1年时4.5%对0.4%；P = 0.009）显著更高。凝血酶原时间延长、血小板计数降低、肝外转移的存在以及Vp4 PVTT是206例PVTT患者中与高危静脉曲张相关的独立危险因素（校正比值比[95%可信区间]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]；P值<0.05）。在中位随访43.2个月期间，10例PVTT患者发生曲张静脉出血事件，其中9例（90%）有高危静脉曲张。高危静脉曲张的存在以及使用索拉非尼治疗HCC是整个PVTT患者组中曲张静脉出血的显著预测因素（校正风险比[95%可信区间]分别为26.432[3.230 - 216.289]；和5.676[1.273 - 25.300]；P值<0.05）。