Does Venous Thromboembolic Events Increase Morbidity and Mortality in Hepatocellular Carcinoma Patients

Abstract

Introduction: Venous thromboembolic event (VTE) are frequently associated with malignancy and leads to increased mortality. Hepatocellular carcinoma (HCC) is often associated with concurrent cirrhosis which derange coagulation-anticoagulation balance, leads to higher risk of VTE. This study aim to characterize VTE in HCC, identify independent risk factors and assess effects of VTE on overall prognosis in HCC. Methods: We retrospectively analyzed patients with diagnosis of hepatocellular carcinoma (by ICD-9 code) at a large public hospital during 10 years (05/2006 through 05/2015). HCC was confirmed by characteristic radiologic features and/or histology from liver biopsy. VTE was further categorized into pulmonary embolism, peripheral deep vein thrombosis, and intra-abdominal thrombosis. We exclude portal vein thrombosis as tumor thrombus from direct invasion could be confounded with bland thrombus. We collected data of patient-related risk factors, tumor characters, laboratory at diagnosis, treatment-related risk factors. We constructed multivariable logistic regression model through STATA V.13. Results: 270 patients with complete dataset were included. Thromboembolism events were identified in 16(5.9%) patients at an average of 6.2 months since diagnosis of HCC: 7(43.8%) pulmonary embolism, 4(25%) peripheral deep vein thrombosis, 6(37.5%) intra-abdominal thrombosis. VTE frequency by etiology of HCC: viral-HCC 2.60% (2/77), alcoholic-HCC 2.5% (1/40), viral-alcoholic-HCC 9.17% (11/120), nonviral-nonalcoholic-HCC 6.06% (2/33). VTE frequency by severity of cirrhosis: non-cirrhotic liver 4.88% (2 cases of 41), Child A 1.03% (1 cases of 97), Child B 11.11% (10 cases of 90), Child C 6.8% (3 cases of 44). Multivariable regression showed independent risk factors for VTE in HCC include: viralalcoholic-HCC (OR 18.7, p=0.017; CI 1.69-207.3), age (OR 2.86, p=0.017; CI 1.21 -6.78), presence of extrahepatic metastasis (OR 7.27, p=0.025; CI 1.29-41.1), BMI (OR 1.15, p=0.020; CI 1.02-1.29). VTE is not an independent risk factor for preclusion from curative treatment, hospice or mortality. Conclusion: VTE occurs in approximately 5.9% of patients with HCC. Patients with viral-alcoholic HCC, elderly patients, patients with higher BMI or extrahepatic metastasis are at higher risk of developing VTE; cirrhosis severity by child score is not independent risk factor. VTE does not affect overall prognosis after HCC diagnosis.