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HCC complicated by PVT: Outcome and the role of anticoagulation therapy
T Malek Mahmoudi1, Vladimir Marquez2, Ahmed Kayal3
1Division of Gastroenterology, University of Missouri-Kansas City, Kansas City, Missouri, USA.
Insights
Anticoagulation (AC) therapy may improve survival for patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT). While AC did not affect PVT progression, it was linked to better outcomes in HCC patients with PVT.
Area of Science:
- Hepatology
- Oncology
- Hematology
Background:
- Hepatocellular carcinoma (HCC) is a primary liver cancer.
- Portal vein thrombosis (PVT) is a common complication in HCC patients.
- The clinical impact of anticoagulation (AC) in HCC patients with PVT is not fully understood.
Purpose of the Study:
- To investigate the clinical impact of PVT on patients with HCC.
- To evaluate the effectiveness of anticoagulation (AC) therapy in HCC patients with PVT.
Main Methods:
- Retrospective study of 51 HCC patients with PVT.
- Patients were divided into two groups: those treated with AC (12 patients) and those not treated with AC (39 patients).
- Diagnosis and follow-up of HCC and PVT were performed using contrast-enhanced CT or MRI.
Main Results:
- No significant difference in PVT progression was observed between the AC and non-AC groups (49% vs. 50%).
- Anticoagulation (AC) therapy was associated with improved survival after HCC diagnosis (adjusted HR = 0.37) and PVT diagnosis (adjusted HR = 0.34).
- No PVT-related symptoms were reported in either group.
Conclusions:
- Anticoagulation (AC) therapy may offer a survival advantage for patients with HCC and PVT.
- AC-related complications should be considered before initiating therapy.
- Further research is warranted to confirm the role of AC in managing HCC with PVT.
Background:
This retrospective study investigated the clinical impact of PVT on the course of patients with HCC who were and were not treated with anticoagulation (AC).
Methods:
We retrospectively evaluated a cohort of 60 patients diagnosed with HCC and PVT. Nine patients were excluded for lack of follow-up. HCC, PVT diagnosis, and imaging follow-up were performed using contrast-enhanced computed tomography or MRI. Of the 51 patients evaluated, 12 received AC and 39 did not.
Results:
Forty-two patients were male; mean age was 60.3 years. Mean survival after HCC diagnosis was 32.9 months; after PVT diagnosis, it was 18.4 months. No symptoms directly related to PVT development were reported. AC therapy was initiated for 12 patients and had to be discontinued for 3 patients because of complications. AC was not associated with a difference in PVT progression (49% in non-AC group vs. 50% in AC group). After adjusting for age, HCC type (single vs. multifocal), and Child-Pugh score, AC was associated with an improved survival after HCC diagnosis (adjusted hazard ratio [HR] = 0.37; 95% confidence interval [CI] 0.14 to 0.99) and after PVT diagnosis (HR = 0.34; 95% CI 0.13 to 0.88).
Conclusion:
Patients with HCC complicated by PVT in both AC and non-AC groups had a similar rate of progression. Neither group had symptoms attributable to PVT. Possible AC-related complications need to be considered before proceeding with therapy in patients with HCC and PVT. AC may be associated with a survival advantage in patients with HCC and PVT.
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