Portal Vein Thrombosis in Pakistani Population with Hepatocellular Carcinoma – Prevalence and Risk Factors

Abstract

Introduction: Hepatocellular carcinoma (HCC) is frequently associated with portal vein thrombosis (PVT) with reported incidence ranging from 30 to 40% in different studies. PVT may be associated with poor prognosis, limiting the available treatment options for these patients. The objective of our study was to determine the prevalence and risk factors of PVT in HCC in the Pakistani population. Method: Retrospective analysis was performed on the prospectively collected data from January 2018 to March 2020. All patients with HCC discussed in our weekly multidisciplinary liver clinic during the specified period were reviewed. The patients with PVT were analyzed to determine the frequency and factors associated with PVT. Result: Of 316 patients with HCC discussed in our liver clinic, the prevalence of PVT was 31% (98 patients). The site of thrombosis included the main portal vein in 38(12%) and branch portal vein in 58(18.4%) patients; while 2(0.6%) patients had thrombosis in other systemic veins along with PVT. On univariate analysis, factors associated with PVT included abdominal pain (p=0.047), jaundice (p=0.012), raised alpha-fetoprotein (AFP) levels (p=0.000), deranged bilirubin levels (p=0.004), large tumor size (p=0.000), ascites (p=0.003), higher MELD score (p=0.004) and Child-Pugh classification B or C (p=0.001). On multivariate analysis, larger tumor size (p=0.000), raised AFP level (p=0.036) and higher Child-Pugh class (p=0.008) were significantly associated with PVT in HCC. Conclusion: The prevalence of PVT in our HCC patients is 31%. We identified the factors associated with PVT in our population which may be used for additional screening of high-risk patients.