Management of varices but not anticoagulation is associated with improved outcome in patients with HCC and macrovascular tumour invasion
Abstract Background & aims The value of bleeding prophylaxis and anticoagulation in patients with hepatocellular carcinoma (HCC) and macrovascular tumour invasion (MVI) is unclear. We evaluated the impact of anticoagulation on thrombosis progression, bleeding events, and overall mortality, and a...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Cancer Imaging |
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| Online Access: | https://doi.org/10.1186/s40644-024-00657-z |
| _version_ | 1797355482293207040 |
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| author | Lorenz Balcar Arpad Mrekva Bernhard Scheiner Katharina Pomej Tobias Meischl Mattias Mandorfer Thomas Reiberger Michael Trauner Dietmar Tamandl Matthias Pinter |
| author_facet | Lorenz Balcar Arpad Mrekva Bernhard Scheiner Katharina Pomej Tobias Meischl Mattias Mandorfer Thomas Reiberger Michael Trauner Dietmar Tamandl Matthias Pinter |
| author_sort | Lorenz Balcar |
| collection | DOAJ |
| description | Abstract Background & aims The value of bleeding prophylaxis and anticoagulation in patients with hepatocellular carcinoma (HCC) and macrovascular tumour invasion (MVI) is unclear. We evaluated the impact of anticoagulation on thrombosis progression, bleeding events, and overall mortality, and assessed the efficacy of adequate management of varices as recommended for patients with cirrhosis. Methods HCC patients with MVI who had Child-Turcotte-Pugh A-B7 were included between Q4/2002 and Q2/2022. Localization of the tumour thrombus and changes at 3–6 months were evaluated by two radiologists. Univariable and multivariable logistic/Cox regression analyses included time-dependent variables (i.e., anticoagulation, systemic therapy, non-selective beta blocker treatment). Results Of 124 patients included (male: n = 110, 89%), MVI involved the main portal vein in 47 patients (38%), and 49 individuals (40%) had additional non-tumorous thrombus apposition. Fifty of 80 patients (63%) with available endoscopy had varices. Twenty-four individuals (19%) received therapeutic anticoagulation and 94 patients (76%) were treated with effective systemic therapies. The use of therapeutic anticoagulation did not significantly affect the course of the malignant thrombosis at 3–6 months. Systemic therapy (aHR: 0.26 [95%CI: 0.16–0.40]) but not anticoagulation was independently associated with reduced all-cause mortality. In patients with known variceal status, adequate management of varices was independently associated with reduced risk of variceal bleeding (aHR: 0.12 [95%CI: 0.02–0.71]). In the whole cohort, non-selective beta blockers were independently associated with reduced risk of variceal bleeding or death from any cause (aHR: 0.69 [95%CI: 0.50–0.96]). Conclusion Adequate bleeding prophylaxis and systemic anti-tumour therapy but not anticoagulation were associated with improved outcomes in patients with HCC and MVI. |
| first_indexed | 2024-03-08T14:12:46Z |
| format | Article |
| id | doaj.art-01689d25002646a9be02d479c0cabf36 |
| institution | Directory Open Access Journal |
| issn | 1470-7330 |
| language | English |
| last_indexed | 2024-03-08T14:12:46Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Cancer Imaging |
| spelling | doaj.art-01689d25002646a9be02d479c0cabf362024-01-14T12:34:57ZengBMCCancer Imaging1470-73302024-01-0124111110.1186/s40644-024-00657-zManagement of varices but not anticoagulation is associated with improved outcome in patients with HCC and macrovascular tumour invasionLorenz Balcar0Arpad Mrekva1Bernhard Scheiner2Katharina Pomej3Tobias Meischl4Mattias Mandorfer5Thomas Reiberger6Michael Trauner7Dietmar Tamandl8Matthias Pinter9Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDepartment of Biomedical Imaging and Image-Guided Therapy, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDepartment of Biomedical Imaging and Image-Guided Therapy, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaAbstract Background & aims The value of bleeding prophylaxis and anticoagulation in patients with hepatocellular carcinoma (HCC) and macrovascular tumour invasion (MVI) is unclear. We evaluated the impact of anticoagulation on thrombosis progression, bleeding events, and overall mortality, and assessed the efficacy of adequate management of varices as recommended for patients with cirrhosis. Methods HCC patients with MVI who had Child-Turcotte-Pugh A-B7 were included between Q4/2002 and Q2/2022. Localization of the tumour thrombus and changes at 3–6 months were evaluated by two radiologists. Univariable and multivariable logistic/Cox regression analyses included time-dependent variables (i.e., anticoagulation, systemic therapy, non-selective beta blocker treatment). Results Of 124 patients included (male: n = 110, 89%), MVI involved the main portal vein in 47 patients (38%), and 49 individuals (40%) had additional non-tumorous thrombus apposition. Fifty of 80 patients (63%) with available endoscopy had varices. Twenty-four individuals (19%) received therapeutic anticoagulation and 94 patients (76%) were treated with effective systemic therapies. The use of therapeutic anticoagulation did not significantly affect the course of the malignant thrombosis at 3–6 months. Systemic therapy (aHR: 0.26 [95%CI: 0.16–0.40]) but not anticoagulation was independently associated with reduced all-cause mortality. In patients with known variceal status, adequate management of varices was independently associated with reduced risk of variceal bleeding (aHR: 0.12 [95%CI: 0.02–0.71]). In the whole cohort, non-selective beta blockers were independently associated with reduced risk of variceal bleeding or death from any cause (aHR: 0.69 [95%CI: 0.50–0.96]). Conclusion Adequate bleeding prophylaxis and systemic anti-tumour therapy but not anticoagulation were associated with improved outcomes in patients with HCC and MVI.https://doi.org/10.1186/s40644-024-00657-zLiver cancerBeta blockersVariceal bleedingPortal hypertensionVarices |
| spellingShingle | Lorenz Balcar Arpad Mrekva Bernhard Scheiner Katharina Pomej Tobias Meischl Mattias Mandorfer Thomas Reiberger Michael Trauner Dietmar Tamandl Matthias Pinter Management of varices but not anticoagulation is associated with improved outcome in patients with HCC and macrovascular tumour invasion Cancer Imaging Liver cancer Beta blockers Variceal bleeding Portal hypertension Varices |
| title | Management of varices but not anticoagulation is associated with improved outcome in patients with HCC and macrovascular tumour invasion |
| title_full | Management of varices but not anticoagulation is associated with improved outcome in patients with HCC and macrovascular tumour invasion |
| title_fullStr | Management of varices but not anticoagulation is associated with improved outcome in patients with HCC and macrovascular tumour invasion |
| title_full_unstemmed | Management of varices but not anticoagulation is associated with improved outcome in patients with HCC and macrovascular tumour invasion |
| title_short | Management of varices but not anticoagulation is associated with improved outcome in patients with HCC and macrovascular tumour invasion |
| title_sort | management of varices but not anticoagulation is associated with improved outcome in patients with hcc and macrovascular tumour invasion |
| topic | Liver cancer Beta blockers Variceal bleeding Portal hypertension Varices |
| url | https://doi.org/10.1186/s40644-024-00657-z |
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