Risk factors of rebleeding after endoscopic treatment of patients with portal vein tumor thrombus and esophagogastric variceal bleeding

Xiuxia LIANG; Lingling HE; Junru YANG; Fuyang ZHANG; Jiali MA; Yuling ZHOU; Julong HU; Ping LI; Hongshan WEI

doi:10.3969/j.issn.1001-5256.2022.10.017

Volume 38 Issue 10

Oct. 2022

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Article Navigation > Journal of Clinical Hepatology > 2022 > 38(10): 2290-2295

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Risk factors of rebleeding after endoscopic treatment of patients with portal vein tumor thrombus and esophagogastric variceal bleeding

DOI: 10.3969/j.issn.1001-5256.2022.10.017

Department of Gastroenterology, Beijing Ditan Hospital, The Capital Medical University, Beijing 100015, China

Research funding:

National Natural Science Foundation of China (82170541);

Digestive Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals (XXZ0404);

Natural Science Foundation of Capital Medical University (PYZ20031)

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Corresponding author: WEI Hongshan, drwei@ccmu.edu.cn(ORCID: 0000-0001-8893-653X)
Received Date: 2022-03-09
Accepted Date: 2022-06-06
Published Date: 2022-10-20

Abstract

Abstract

Objective To analyze the rebleeding rate in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) after endoscopic treatment of esophagogastric variceal bleeding and then assessed the risk factors of the rebleeding in the patients. Methods This study retrospectively recruited 169 hepatitis B-associated HCC patients complicated with PVTT and esophagogastric variceal bleeding treated by endoscopy in Department of Gastroenterology, Beijing Ditan Hospital from September 2008 to December 2016. Among them, 47 patients had PVTT Ⅱ, 67 patients had PVTT Ⅲ, and 55 patients had PVTT Ⅳ. Their clinicopathological and follow-up data were retrieved from the medical records and statistically analyzed. Continuous data were compared among groups using ANOVA or Kruskal-Wallis H test. Categorial data were compared among groups using Chi-square test or corrected Fisher test. The Kaplan-Meier curves and Log-rank test were performed to analyze the rebleeding rate and cumulative survival rates after treatment. The univariate multivariate Cox regression analyses were used to identify the risk factors affecting the rebleeding of patients. Results Compared with PVTT Ⅱ and Ⅲ, PVTT Ⅳ patients had a higher serum level of the direct bilirubin (Z=6.153, P=0.046). The endoscopy treatment successfully blocked esophagogastric variceal bleeding in all patients. There was no significant difference in the rebleeding rates within six months and a year after the treatment (all P > 0.05). It was also no statistically significant difference in cumulative survival rates in six months and l-, 2-, and 3-year after the treatment in PVTT Ⅱ, Ⅲ, and Ⅳ patients (all P > 0.05). Cox multivariate regression analysis showed that hepatic encephalopathy (HR=3.643, 95%CI: 2.099-6.325, P < 0.001), γ-glutamyltransferase (HR=1.002, 95%CI: 1.000-1.005, P=0.029), AFP (HR=1.000, 95%CI: 1.000-1.000, P=0.002) and numbers of tumor lesions (HR=1.647, 95%CI: 1.011-2.684, P=0.045) were all independent risk factors for 1-year rebleeding in these PVTT patients with esophagogastric variceal bleeding after endoscopic treatment. Conclusion Endoscopic hemostasis is a feasible treatment option for HCC patients with PVTT and esophagogastric variceal bleeding. However, there was no significant difference in the rebleeding and cumulative survival rates in these patients. Furthermore, hepatic encephalopathy, γ-glutamyltransferase, AFP and numbers of tumor lesions were all independent risk factors for 1-year rebleeding in these patients.
- Carcinoma, Hepatocellular,
- Portal Vein,
- Esophageal and Gastric Varices,
- Endoscopes,
- Therapeutics,
- Hemorrhage

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References(21)

References

[1]	ZHANG FB, ZHANG CJ, JIANG HC. Current status and progress of treatment for hepatocellular carcinoma with portal vein tumor thrombus[J]. Chin J Dig Surg, 2021, 20(5): 568-573. DOI: 10.3760/cma.j.cn115610-20210302-00105. 张凤博, 张春娇, 姜洪池. 肝细胞癌合并门静脉癌栓的治疗现状及进展[J]. 中华消化外科杂志, 2021, 20(5): 568-573. DOI: 10.3760/cma.j.cn115610-20210302-00105.
[2]	CERRITO L, ANNICCHIARICO BE, IEZZI R, et al. Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers[J]. World J Gastroenterol, 2019, 25(31): 4360-4382. DOI: 10.3748/wjg.v25.i31.4360.
[3]	CHENG SQ, WU MC, CHEN H, et al. A study on imagination features of tumor thrombi in the portal vein of primary liver cancer[J]. Chin J Gen Surg, 2004, 19(4): 200-201. DOI: 10.3760/j.issn:1007-631X.2004.04.002. 程树群, 吴孟超, 陈汉, 等. 肝癌门静脉癌栓分型的影像学意义[J]. 中华普通外科杂志, 2004, 19(4): 200-201. DOI: 10.3760/j.issn:1007-631X.2004.04.002.
[4]	SHI J, LAI EC, LI N, et al. A new classification for hepatocellular carcinoma with portal vein tumor thrombus[J]. J Hepatobiliary Pancreat Sci, 2011, 18(1): 74-80. DOI: 10.1007/s00534-010-0314-0.
[5]	XIANG X, LAU WY, WU ZY, et al. Transarterial chemoembolization versus best supportive care for patients with hepatocellular carcinoma with portal vein tumor thrombus: a multicenter study[J]. Eur J Surg Oncol, 2019, 45(8): 1460-1467. DOI: 10.1016/j.ejso.2019.03.042.
[6]	HE L, LI P, JIANG Y, et al. A new algorithm for predicting long-term survival in chronic hepatitis B patients with variceal bleeding after endoscopic therapy[J]. Dig Liver Dis, 2019, 51(8): 1166-1171. DOI: 10.1016/j.dld.2019.01.004.
[7]	LI QS. Research status of endoscopic treatments in esophageal and gastric varices bleeding[J/CD]. Chin J Gastrointestinal Endoscopy (Electroic Edition), 2017, 4(3): 126-129. DOI: 10.3877/cma.j.issn.2095-7157.2017.03.007. 李球森. 食管胃底静脉曲张破裂出血内镜下治疗进展[J/CD]. 中华胃肠内镜电子杂志, 2017, 4(3): 126-129. DOI: 10.3877/cma.j.issn.2095-7157.2017.03.007.
[8]	Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Endoscopy, Chinese Medical Association. Consensus on prevention and treatment of esophagogastric variceal bleeding in patients with cirrhotic portal hypertension (2008, Hangzhou)[J]. Chin J Dig, 2008, 28(8): 551-558. DOI: 10.3760/j.issn:0254-1432.2008.08.012. 中华医学会消化病学分会, 中华医学会肝病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治共识(2008, 杭州)[J]. 中华消化杂志, 2008, 28(8): 551-558. DOI: 10.3760/j.issn:0254-1432.2008.08.012.
[9]	General Office of National Health Commission. Standard for diagnosis and treatment of primary liver cancer (2022 edition)[J]. J Clin Hepatol, 2022, 38(2): 288-303. DOI: 10.3969/j.issn.1001-5256.2022.02.009. 国家卫生健康委办公厅. 原发性肝癌诊疗指南(2022年版)[J]. 临床肝胆病杂志, 2022, 38(2): 288-303. DOI: 10.3969/j.issn.1001-5256.2022.02.009.
[10]	MANZANO-ROBLEDA MDEL C, BARRANCO-FRAGOSO B, URIBE M, et al. Portal vein thrombosis: what is new?[J]. Ann Hepatol, 2015, 14(1): 20-27. DOI: 10.1016/S1665-2681(19)30797-5.
[11]	KATAGIRI S, YAMAMOTO M. Multidisciplinary treatments for hepatocellular carcinoma with major portal vein tumor thrombus[J]. Surg Today, 2014, 44(2): 219-226. DOI: 10.1007/s00595-013-0585-6.
[12]	Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Endoscopy, Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002. 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002.
[13]	ZHU XD, HUANG C, SHEN YH, et al. Downstaging and Resection of Initially Unresectable Hepatocellular Carcinoma with Tyrosine Kinase Inhibitor and Anti-PD-1 Antibody Combinations[J]. Liver Cancer, 2021, 10(4): 320-329. DOI: 10.1159/000514313.
[14]	MA JL, JIANG Y, HU JL, et al. Risk factors for rebleeding after endoscopic selective variceal devascularization in patients with hepatitis B cirrhosis and acute variceal bleeding[J]. J Clin Hepatol, 2021, 37(11): 2569-2574. DOI: 10.3969/j.issn.1001-5256.2021.11.017. 马佳丽, 蒋煜, 胡居龙, 等. 内镜下精准食管胃静脉曲张断流术治疗乙型肝炎肝硬化伴急性静脉曲张出血患者再出血的危险因素分析[J]. 临床肝胆病杂志, 2021, 37(11): 2569-2574. DOI: 10.3969/j.issn.1001-5256.2021.11.017.
[15]	HUANG JY, SONG YS. The discussion of risk factors for portal hypertension and cirrhosis with esophageal and gastric varices bleeding[J]. Chin Foreign Med Res, 2018, 16(25): 179-181. DOI: 10.14033/j.cnki.cfmr.2018.25.086. 黄建英, 宋永树. 肝硬化合并门静脉血栓形成与食管胃底静脉曲张破裂出血的危险因素探讨[J]. 中外医学研究, 2018, 16(25): 179-181. DOI: 10.14033/j.cnki.cfmr.2018.25.086.
[16]	TONG QH, PENG T, DING Y. Clinical features and prognosis of cirrhosis complicated with upper gastrointestinal bleeding[J]. Lab Med Clin, 2017, 14(17): 2627-2629. DOI: 10.3969/j.issn.1672-9455.2017.17.052. 童庆华, 彭涛, 丁云. 肝硬化合并上消化道出血的临床特征及预后分析[J]. 检验医学与临床, 2017, 14(17): 2627-2629. DOI: 10.3969/j.issn.1672-9455.2017.17.052.
[17]	LI Y, TANG QY, LAI CX, et al. Influencing factors of patients with hepatitis B virus-related hepatocellular carcinoma complicated with upper gastrointestinal bleeding[J/CD]. Chin J Liver Diseases(Electronic Version), 2021, 13(3): 56-61. DOI: 10.3969/j.issn.1674-7380.2021.03.009. 李雅, 唐奇远, 赖长祥, 等. 乙型肝炎病毒相关肝细胞癌患者并发上消化道出血的影响因素[J/CD]. 中国肝脏病杂志(电子版), 2021, 13(3): 56-61. DOI: 10.3969/j.issn.1674-7380.2021.03.009.
[18]	PAWARODE A, VORAVUD N, SRIURANPONG V, et al. Natural history of untreated primary hepatocellular carcinoma: a retrospective study of 157 patients[J]. Am J Clin Oncol, 1998, 21(4): 386-391. DOI: 10.1097/00000421-199808000-00014.
[19]	GUO J, LIU S, GAO S, et al. γ-Glutamyltranspeptidase as a prognostic biomarker in advanced hepatocellular carcinoma treated with transarterial chemoembolization[J]. J Vasc Interv Radiol, 2021, 32(3): 419-428. e2. DOI: 10.1016/j.jvir.2020.07.020.
[20]	CHENG S, YU X, LIU S, et al. Development of a prognostic nomogram in hepatocellular carcinoma with portal vein tumor thrombus following trans-arterial chemoembolization with drug-eluting beads[J]. Cancer Manag Res, 2021, 13: 9367-9377. DOI: 10.2147/CMAR.S341672.
[21]	NIU ZJ, MA YL, KANG P, et al. Transarterial chemoembolization compared with conservative treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus: using a new classification[J]. Med Oncol, 2012, 29(4): 2992-2997. DOI: 10.1007/s12032-011-0145-0.

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Risk factors of rebleeding after endoscopic treatment of patients with portal vein tumor thrombus and esophagogastric variceal bleeding

DOI: 10.3969/j.issn.1001-5256.2022.10.017

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Risk factors of rebleeding after endoscopic treatment of patients with portal vein tumor thrombus and esophagogastric variceal bleeding

DOI: 10.3969/j.issn.1001-5256.2022.10.017

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