scholarly journals Macroscopic Portal Vein Thrombosis in HCC Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Hikmet Akkiz ◽  
Brian I. Carr ◽  
Sedef Kuran ◽  
Ümit Karaoğullarından ◽  
Oguz Üsküdar ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Odds Ratio ◽  
Logistic Regression Model ◽  
Tumor Diameter ◽  
Portal Vein Invasion ◽  
Vein Thrombosis ◽  
Tumor Multifocality ◽  
Maximum Tumor Diameter ◽  
Low Levels

Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of the most important negative prognostic factors for HCC patients. The characteristics of a large cohort of such patients were examined. We found that the percent of patients with PVT significantly increased with increasing maximum tumor diameter (MTD), from 13.7% with tumors of MTD <5cm to 56.4% with tumors of MTD >10cm. There were similar numbers of HCC patients with very large tumors with and without PVT. Thus, MTD alone was insufficient to explain the presence of PVT, as were high AFP levels, since less than 50% of high AFP patients had PVT. However, the percent of patients with PVT was also found to significantly increase with increasing blood alpha-fetoprotein (AFP) levels and tumor multifocality. A logistic regression model that included these 3 factors together showed an odds ratio of 17.9 for the combination of MTD>5.0cm plus tumor multifocality plus elevated AFP, compared to low levels of these 3 parameters. The presence or absence of macroscopic PVT may therefore represent different HCC aggressiveness phenotypes, as judged by a significant increase in tumor multifocality and AFP levels in the PVT positive patients. Factors in addition to MTD and AFP must also contribute to PVT development.

scholarly journals Changes in hepatocellular carcinoma aggressiveness characteristics with an increase in tumor diameter

2021 ◽  
pp. 172460082199637
Author(s):  
Brian I. Carr ◽  
Vito Guerra ◽  
Rossella Donghia ◽  
Fabio Farinati ◽  
Edoardo G. Giannini ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Survival Data ◽  
Alpha Fetoprotein ◽  
Tumor Diameter ◽  
Vein Thrombosis ◽  
Tumor Multifocality ◽  
Maximum Tumor Diameter ◽  
Tumor Sampling

Background: Hepatocellular carcinoma prognosis depends on both liver and tumor determinants, especially on maximum tumor diameter, multifocality, and presence of portal vein thrombosis, despite apparently complete tumor removal by resection or liver transplantation. Aims: To examine parameters of hepatocellular carcinoma aggressiveness as tumor size increases. Methods: A large hepatocellular carcinoma database was examined for trends in serum alpha-fetoprotein and the percentage of patients with macroscopic portal vein thrombosis or tumor multifocality. Results: A total of 13,016 hepatocellular carcinoma patients were identified having full tumor and survival data. Of these, 76.56% were male and 23.44% were female, with a median age of 64.4 years. We found that as the maximum tumor diameter increased, there was a significant trend for increased alpha-fetoprotein levels ( P<0.001) and an increased percentage of patients with either portal vein thrombosis or tumor multifocality, each P<0.0001. Furthermore, the increases of both alpha-fetoprotein and portal vein thrombosis were proportionately greater than the related maximum tumor diameter increases. These trends of increased alpha-fetoprotein, portal vein thrombosis, and multifocality with increasing maximum tumor diameter had non-linear patterns. Within alpha-fetoprotein and multifocality trends, there were identifiable sub-trends associated with specific maximum tumor diameter ranges. Conclusions: The greater fold-increases in alpha-fetoprotein and portal vein thrombosis compared with increases in maximum tumor diameter imply that hepatocellular carcinoma characteristics may change with increasing size to a more aggressive phenotype, suggesting that follow-up tumor sampling might be useful, in addition to baseline tumor sampling, for optimal therapeutic choices to be made.

scholarly journals Serum Albumin Levels in Relation to Tumor Parameters in Hepatocellular Carcinoma Patients

2017 ◽  
Vol 32 (4) ◽  
pp. 391-396 ◽  
Author(s):  
Brian I. Carr ◽  
Vito Guerra
Keyword(s):  
Hepatocellular Carcinoma ◽  
Serum Albumin ◽  
Prognostic Significance ◽  
Tumor Diameter ◽  
Lower Serum ◽  
Vein Thrombosis ◽  
Inflammatory Index ◽  
Tumor Multifocality ◽  
Relationship Of ◽  
Low Serum

Background Serum albumin levels have been shown to have prognostic significance in hepatocellular carcinoma (HCC), as part of an inflammatory index. The aim of this study was to examine the possible relationship of serum albumin levels to parameters of HCC aggressiveness. Methods A large HCC patient cohort was retrospectively examined, and the possible relationships of albumin levels to tumor diameter, multifocality, portal vein thrombosis (PVT) and α-fetoprotein levels were examined. Results HCC patients with lower serum albumin levels had significantly larger maximum tumor diameters, greater prevalence of PVT, increased tumor multifocality and higher α-fetoprotein levels, than HCC patients with higher albumin levels. A correlation was found between levels of these tumor parameters and serum albumin levels. Conclusions These results indicate that low serum albumin levels correlate with increased parameter measures of HCC aggressiveness, in addition to their role as a monitor of systemic inflammation. Decreased serum albumin might have a role in HCC aggressiveness.

scholarly journals Identification of Clinical Phenotypes and Related Survival in Patients with Large HCCs

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 592
Author(s):  
Brian I. Carr ◽  
Vito Guerra ◽  
Rossella Donghia ◽  
Fabio Farinati ◽  
Edoardo G. Giannini ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Tumor Diameter ◽  
Clinical Phenotypes ◽  
Vein Thrombosis ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Tumor Multifocality ◽  
Serum Alpha Fetoprotein ◽  
Maximum Tumor Diameter ◽  
Cox Analysis

Background. Hepatocellular carcinoma (HCC) factors, especially maximum tumor diameter (MTD), tumor multifocality, portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP), influence survival. Aim. To examine patterns of tumor factors in large HCC patients. Methods. A database of large HCC patients was examined. Results. A multiple Cox proportional hazard model on death identified low serum albumin levels and the presence of PVT and multifocality, with each having a hazard ratio ≥2.0. All combinations of these three parameters were examined in relation to survival. Using univariate Cox analysis, the combination of albumin >3.5 g/dL and the absence of both PVT and multifocality had the best survival rate, while all combinations that included the presence of PVT had poor survival and hazard ratios. We identified four clinical phenotypes, each with a distinct median survival: patients with or without PVT or multifocality plus serum albumin ≥3.5 (g/dL), with each subgroup displaying high (≥100 IU/mL) or low (<100 IU/mL) blood AFP levels. Across a range of MTDs, we identified only two significant trends, blood AFP and platelets. Conclusions. Patients with large HCCs have distinct phenotypes and survival, as identified by the combination of PVT, multifocality, and blood albumin levels.

Outcomes of Hepatic Resection for Hepatocellular Carcinoma Associated with Portal Vein Invasion

2021 ◽  
Vol 266 ◽  
pp. 269-283
Author(s):  
Ahmed Shehta ◽  
Ahmed Farouk ◽  
Ahmed Nabieh Elghawalby ◽  
Mohamed Elshobary ◽  
Ahmed Aboelenin ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Hepatic Resection ◽  
Portal Vein Invasion

scholarly journals Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma with Portal Vein Thrombosis: A Perspective on Survival

2014 ◽  
Vol 29 (6) ◽  
pp. 430-436 ◽  
Author(s):  
Yadav Ajit ◽  
Hariprasad Sudarsan ◽  
Gupta Saumya ◽  
Agarwal Abhishek ◽  
Redhu Navneet ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Transarterial Chemoembolization ◽  
Vein Thrombosis ◽  
Unresectable Hepatocellular Carcinoma
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