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Hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: Prevalence and clinical significance

BACKGROUND: There is strong evidence that portal vein tumor thrombosis (PVTT) is associated with poor survival in patients with hepatocellular carcinoma (HCC). However, data regarding the clinical significance of hepatic vein tumor thrombosis (HVTT) is rare, particularly in Western patients. OBJECTI...

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Autores principales: Mähringer‐Kunz, Aline, Meyer, Franziska I., Hahn, Felix, Müller, Lukas, Düber, Christoph, Pinto Dos Santos, Daniel, Galle, Peter R., Weinmann, Arndt, Kloeckner, Roman, Schotten, Sebastian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259264/
https://www.ncbi.nlm.nih.gov/pubmed/34077613
http://dx.doi.org/10.1002/ueg2.12098
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author Mähringer‐Kunz, Aline
Meyer, Franziska I.
Hahn, Felix
Müller, Lukas
Düber, Christoph
Pinto Dos Santos, Daniel
Galle, Peter R.
Weinmann, Arndt
Kloeckner, Roman
Schotten, Sebastian
author_facet Mähringer‐Kunz, Aline
Meyer, Franziska I.
Hahn, Felix
Müller, Lukas
Düber, Christoph
Pinto Dos Santos, Daniel
Galle, Peter R.
Weinmann, Arndt
Kloeckner, Roman
Schotten, Sebastian
author_sort Mähringer‐Kunz, Aline
collection PubMed
description BACKGROUND: There is strong evidence that portal vein tumor thrombosis (PVTT) is associated with poor survival in patients with hepatocellular carcinoma (HCC). However, data regarding the clinical significance of hepatic vein tumor thrombosis (HVTT) is rare, particularly in Western patients. OBJECTIVE: To determine the HVTT prevalence in a Western patient population and its impact on survival. METHODS: We included 1310 patients with HCC treated in our tertiary referral center between January 2005 and December 2016. HVTT and PVTT were diagnosed with contrast‐enhanced cross‐sectional imaging. Overall survival (OS) was calculated starting from the initial HCC diagnosis, and in a second step, starting from the first appearance of vascular invasion. RESULTS: We observed macrovascular invasion (MVI) in 519 patients who suffered from either isolated HVTT (n = 40), isolated PVTT (n = 352), or both combined (HVTT + PVTT) (n = 127). Calculated from the initial HCC diagnosis, the median OS for patients with isolated HVTT was significantly shorter than that of patients without MVI (13.3 vs. 32.5 months, p < 0.001). Calculated from the first appearance of MVI, the median OS was similar among patients with isolated HVTT (6.5 months), isolated PVTT (5 months), and HVTT + PVTT (5 months). Multivariate analysis confirmed HVTT as an independent risk factor for poor survival. CONCLUSIONS: HVTT may be more common than typically reported. In most patients, it was accompanied by PVTT. Isolated HVTT occurred less frequently and later than isolated PVTT; however, once developed, it had the same deleterious impact on survival. Therefore, patients with HVTT should be classified as advanced stage of HCC.
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spelling pubmed-82592642021-07-12 Hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: Prevalence and clinical significance Mähringer‐Kunz, Aline Meyer, Franziska I. Hahn, Felix Müller, Lukas Düber, Christoph Pinto Dos Santos, Daniel Galle, Peter R. Weinmann, Arndt Kloeckner, Roman Schotten, Sebastian United European Gastroenterol J Hepatobiliary BACKGROUND: There is strong evidence that portal vein tumor thrombosis (PVTT) is associated with poor survival in patients with hepatocellular carcinoma (HCC). However, data regarding the clinical significance of hepatic vein tumor thrombosis (HVTT) is rare, particularly in Western patients. OBJECTIVE: To determine the HVTT prevalence in a Western patient population and its impact on survival. METHODS: We included 1310 patients with HCC treated in our tertiary referral center between January 2005 and December 2016. HVTT and PVTT were diagnosed with contrast‐enhanced cross‐sectional imaging. Overall survival (OS) was calculated starting from the initial HCC diagnosis, and in a second step, starting from the first appearance of vascular invasion. RESULTS: We observed macrovascular invasion (MVI) in 519 patients who suffered from either isolated HVTT (n = 40), isolated PVTT (n = 352), or both combined (HVTT + PVTT) (n = 127). Calculated from the initial HCC diagnosis, the median OS for patients with isolated HVTT was significantly shorter than that of patients without MVI (13.3 vs. 32.5 months, p < 0.001). Calculated from the first appearance of MVI, the median OS was similar among patients with isolated HVTT (6.5 months), isolated PVTT (5 months), and HVTT + PVTT (5 months). Multivariate analysis confirmed HVTT as an independent risk factor for poor survival. CONCLUSIONS: HVTT may be more common than typically reported. In most patients, it was accompanied by PVTT. Isolated HVTT occurred less frequently and later than isolated PVTT; however, once developed, it had the same deleterious impact on survival. Therefore, patients with HVTT should be classified as advanced stage of HCC. John Wiley and Sons Inc. 2021-06-02 /pmc/articles/PMC8259264/ /pubmed/34077613 http://dx.doi.org/10.1002/ueg2.12098 Text en © 2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Hepatobiliary
Mähringer‐Kunz, Aline
Meyer, Franziska I.
Hahn, Felix
Müller, Lukas
Düber, Christoph
Pinto Dos Santos, Daniel
Galle, Peter R.
Weinmann, Arndt
Kloeckner, Roman
Schotten, Sebastian
Hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: Prevalence and clinical significance
title Hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: Prevalence and clinical significance
title_full Hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: Prevalence and clinical significance
title_fullStr Hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: Prevalence and clinical significance
title_full_unstemmed Hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: Prevalence and clinical significance
title_short Hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: Prevalence and clinical significance
title_sort hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: prevalence and clinical significance
topic Hepatobiliary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259264/
https://www.ncbi.nlm.nih.gov/pubmed/34077613
http://dx.doi.org/10.1002/ueg2.12098
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