Mo1050 The Liver Protection Effect of L-Carnitine Administration After TACE on Intermediate-Stage Hepatocellular Carcinoma Patients

Abstract

Background: Hepatocellular (HCC) and Cholangiocellular carcinomas (CCA) are the two most common primary liver malignancies affecting the population worldwide and associated with dismal outcomes. Venous thrombosis is often present in patients with liver malignancies and complicates clinical management. It is not clear whether HCC and CCA are associated with different patterns of venous thrombosis since HCC is usually associated with cirrhosis which by itself promotes hypercoagulability. The true frequency and distribution of venous thrombosis in the patients with HCC and CCA is also poorly described. Aim: The goal of the study was to assess the differences in frequency and distribution of portal and nonportal venous thrombosis (PVT and NPVT) in patients with HCC and CCA. Methods: We conducted the retrospective review of the medical records of the 1185 consecutive patients with pathology proven HCC and 559 with pathology proven CCA seen at a tertiary care medical center (Mayo Clinic, Rochester, MN, USA) between 2000 and 2013. The frequency of the venous thrombosis and baseline demographic characteristics were analyzed. Results: Among patients with HCC, 45.6% (540/1185) had associated venous thrombosis. This was comparable to patients with CCA (35.4%; 198/559). Portal venous thrombosis was present in 31% of patients with HCC and 23.4% of patients with CCA. Non-portal venous thrombosis was observed twice less frequently as compared to portal VT and was present in 14.2% of patients with HCC and 12% of patients with CCA. The average age of patients with HCC was similar in portal and non-portal venous thrombosis groups (60 versus 59.5 years respectively) and was comparable to those patients with HCC who did not have venous thrombosis (62 years). This was also true for the patients with CCA where average age of patients with portal venous thrombosis was 61.5 years and non-portal venous thrombosis 62.5 years as compared to average age of 61 years in patients with CCA without venous thrombosis. Across all patient groups (HCC: PVT; HCC:NPVT; CCA:PVT; and CCA:NPVT) male to female ratio was approximately 1:2. Interestingly, females with non-portal venous thrombosis were slightly younger in the HCC group as compared to the CCA group (59 and 65 years respectively). Conclusions: The frequencies of portal and non-portal venous thrombosis are similar in patients with HCC and CCA making radiological and clinical differentiation of these malignancies based only on the distribution of venous thrombosis difficult. The similarity in the venous thrombotic pattern in HCC and CCA points toward a common pathogenesis, and is not likely to be increased by the underlying cirrhosis in HCC.