Clinical risk factors for portal hypertension-related complications in systemic therapy for hepatocellular carcinoma.

Abstract

During systemic therapy, the management of portal hypertension (PH)-related complications is vital. This study aimed to clarify factors associated with the incidence and exacerbation of PH-related complications, including the usefulness of contrast-enhanced computed tomography (CECT) in the management of PH-related complications during systemic therapy. A total of 669 patients who received systemic therapy as first-line treatment (443 patients for sorafenib, 131 for lenvatinib, and 90 for atezolizumab/bevacizumab [ATZ/BEV]) were enrolled in this retrospective study. Additionally, the lower esophageal intramural vessel diameters (EIV) on CECT and endoscopic findings in 358 patients were compared. The cutoff values of the EIV diameter on CECT were 3.1mm for small, 5.1mm for medium, and 7.6mm for large varices, demonstrating high concordance with the endoscopic findings. esophageal varices (EV) bleeding predictors include EIV ≥ 3.1mm and portal vein tumor thrombosis (PVTT). In patients without EV before systemic therapy, factors associated with EV exacerbation after 3months were EIV ≥ 1.9mm and ATZ/BEV use. Predictors of hepatic encephalopathy (HE) include the ammonia level or portosystemic shunt diameter ≥ 6.8mm. The incidence of HE within 2weeks was significantly higher (18%) in patients with an ammonia level ≥ 73μmol/L and a portosystemic shunt ≥ 6.8mm. The exacerbating factors for ascites after 3months were PVTT and low albumin levels. Careful management is warranted for patients with risk factors for exacerbation of PH-related complications; moreover, the effective use of CECT is clinically important.