HCC portal hypertension imaging score derived from CT predicts re-bleeding and mortality after acute variceal bleeding
Abstract Background/Purpose Risk factors for re-bleeding and death after acute variceal bleeding (AVB) in cirrhotic HCC patients are not fully understood.We aimed to (1) explore how the combination of high-risk esophageal varices, HCC status, and portal vein tumor thrombus (i.e., HCC Portal Hyperten...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Cancer Imaging |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40644-024-00689-5 |
| _version_ | 1797233280691470336 |
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| author | Mingyuan Zhao Binyue Zhang Jianqiang Shi Xiaoxian Tang Hongxia Li Shengwen Li Yunfeng Yang Yi Han Rong Wang Jian Xun Kai Zhang Xirun Wu Jiang Zhao |
| author_facet | Mingyuan Zhao Binyue Zhang Jianqiang Shi Xiaoxian Tang Hongxia Li Shengwen Li Yunfeng Yang Yi Han Rong Wang Jian Xun Kai Zhang Xirun Wu Jiang Zhao |
| author_sort | Mingyuan Zhao |
| collection | DOAJ |
| description | Abstract Background/Purpose Risk factors for re-bleeding and death after acute variceal bleeding (AVB) in cirrhotic HCC patients are not fully understood.We aimed to (1) explore how the combination of high-risk esophageal varices, HCC status, and portal vein tumor thrombus (i.e., HCC Portal Hypertension Imaging Score [HCCPHTIS]) helps predict increased risk of variceal re-bleeding and mortality; (2) assess predictability and reproducibility of the identified variceal re-bleeding rules. Methods This prospective study included 195 HCC patients with first-time AVB and liver cirrhosis, and conducted multivariable Cox regression analysis and Kaplan-Meier analysis. Receiver operating characteristic curve analysis was calculated to find the optimal sensitivity, specificity, and cutoff values of the variables. The reproducibility of the results obtained was verified in a different but related group of patients. Results 56 patients (28.7%) had re-bleeding within 6 weeks; HCCPHTIS was an independent risk factor for variceal re-bleeding after AVB (Odd ratio, 2.330; 95% confidence interval: 1.728–3.142, p < 0.001). The positive predictive value of HCCPHTIS cut off value > 3 was 66.2%, sensitivity 83.9%, and specificity 82.3%. HCCPHTIS area under the curve was higher than Child-Pugh score (89% vs. 75%, p < 0.001). 74(37.9%) death occurred within 6 weeks; HCCPHTIS > 4 was associated with increased risk of death within 6 weeks after AVB (p < 0.001). Conclusion HCCPHTIS > 3 is a strong predictor of variceal re-bleeding within the first 6 weeks. However, patients with HCCPHTIS > 4 were at increased risk of death within 6 weeks. |
| first_indexed | 2024-04-24T16:13:40Z |
| format | Article |
| id | doaj.art-c6575a8cf46c4f8584aaf1bcf9de99c5 |
| institution | Directory Open Access Journal |
| issn | 1470-7330 |
| language | English |
| last_indexed | 2024-04-24T16:13:40Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Cancer Imaging |
| spelling | doaj.art-c6575a8cf46c4f8584aaf1bcf9de99c52024-03-31T11:33:52ZengBMCCancer Imaging1470-73302024-03-0124111010.1186/s40644-024-00689-5HCC portal hypertension imaging score derived from CT predicts re-bleeding and mortality after acute variceal bleedingMingyuan Zhao0Binyue Zhang1Jianqiang Shi2Xiaoxian Tang3Hongxia Li4Shengwen Li5Yunfeng Yang6Yi Han7Rong Wang8Jian Xun9Kai Zhang10Xirun Wu11Jiang Zhao12Department of Oncology, Shanxi Provincial People’s Hospital, Affiliated to Shanxi Medical UniversityDepartment of surgery, Shanxi Medical UniversityDepartment of Radiology, Shanxi Provincial People’s Hospital, Affiliated to Shanxi Medical UniversityDepartment of Radiology, Shanxi Provincial People’s Hospital, Affiliated to Shanxi Medical UniversityDepartment of Oncology, Shanxi Provincial People’s Hospital, Affiliated to Shanxi Medical UniversityDepartment of Oncology, Shanxi Provincial People’s Hospital, Affiliated to Shanxi Medical UniversityDepartment of Hepatology, Shanxi Provincial People’s Hospital, Affiliated to Shanxi Medical UniversityDepartment of Hepatology, Shanxi Provincial People’s Hospital, Affiliated to Shanxi Medical UniversityDepartment of Hepatology, Shanxi Provincial People’s Hospital, Affiliated to Shanxi Medical UniversityDepartment of Hepatology, Taiyuan No.3 Hospital Affiliated to Shanxi Medical UniversityDepartment of Radiology, Taiyuan No.3 Hospital Affiliated to Shanxi Medical UniversityDepartment of Hepatology, Second Hospital of Shanxi Medical UniversityDepartment of Hepatology, Shanxi Provincial People’s Hospital, Affiliated to Shanxi Medical UniversityAbstract Background/Purpose Risk factors for re-bleeding and death after acute variceal bleeding (AVB) in cirrhotic HCC patients are not fully understood.We aimed to (1) explore how the combination of high-risk esophageal varices, HCC status, and portal vein tumor thrombus (i.e., HCC Portal Hypertension Imaging Score [HCCPHTIS]) helps predict increased risk of variceal re-bleeding and mortality; (2) assess predictability and reproducibility of the identified variceal re-bleeding rules. Methods This prospective study included 195 HCC patients with first-time AVB and liver cirrhosis, and conducted multivariable Cox regression analysis and Kaplan-Meier analysis. Receiver operating characteristic curve analysis was calculated to find the optimal sensitivity, specificity, and cutoff values of the variables. The reproducibility of the results obtained was verified in a different but related group of patients. Results 56 patients (28.7%) had re-bleeding within 6 weeks; HCCPHTIS was an independent risk factor for variceal re-bleeding after AVB (Odd ratio, 2.330; 95% confidence interval: 1.728–3.142, p < 0.001). The positive predictive value of HCCPHTIS cut off value > 3 was 66.2%, sensitivity 83.9%, and specificity 82.3%. HCCPHTIS area under the curve was higher than Child-Pugh score (89% vs. 75%, p < 0.001). 74(37.9%) death occurred within 6 weeks; HCCPHTIS > 4 was associated with increased risk of death within 6 weeks after AVB (p < 0.001). Conclusion HCCPHTIS > 3 is a strong predictor of variceal re-bleeding within the first 6 weeks. However, patients with HCCPHTIS > 4 were at increased risk of death within 6 weeks.https://doi.org/10.1186/s40644-024-00689-5Variceal re-bleedingMortalityHCCLiver cirrhosisSpecificity |
| spellingShingle | Mingyuan Zhao Binyue Zhang Jianqiang Shi Xiaoxian Tang Hongxia Li Shengwen Li Yunfeng Yang Yi Han Rong Wang Jian Xun Kai Zhang Xirun Wu Jiang Zhao HCC portal hypertension imaging score derived from CT predicts re-bleeding and mortality after acute variceal bleeding Cancer Imaging Variceal re-bleeding Mortality HCC Liver cirrhosis Specificity |
| title | HCC portal hypertension imaging score derived from CT predicts re-bleeding and mortality after acute variceal bleeding |
| title_full | HCC portal hypertension imaging score derived from CT predicts re-bleeding and mortality after acute variceal bleeding |
| title_fullStr | HCC portal hypertension imaging score derived from CT predicts re-bleeding and mortality after acute variceal bleeding |
| title_full_unstemmed | HCC portal hypertension imaging score derived from CT predicts re-bleeding and mortality after acute variceal bleeding |
| title_short | HCC portal hypertension imaging score derived from CT predicts re-bleeding and mortality after acute variceal bleeding |
| title_sort | hcc portal hypertension imaging score derived from ct predicts re bleeding and mortality after acute variceal bleeding |
| topic | Variceal re-bleeding Mortality HCC Liver cirrhosis Specificity |
| url | https://doi.org/10.1186/s40644-024-00689-5 |
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