Risk factors of malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma

Abstract

Introduction Hepatocellular carcinoma (HCC) is the sixth most commonly occurring cancer in the world and the second largest contributor to cancer mortality. In Egypt, liver cancer forms 11.75% of the malignancies of all digestive organs and 1.68% of the total malignancies. HCC constitutes 70.48% of all liver tumors among Egyptians. Malignant portal vein thrombosis (PVT) is a common phenomenon and is associated with poor prognosis. Knowing the risk factors of malignant PVT in HCC helps us in the management of the disease. Objective The objective of this study was to evaluate the risk factors of malignant PVT in cirrhotic patients with HCC. Patients and methods This was a case–control study that included 100 patients of HCC on top of liver cirrhosis. A total of 50 patients had HCC with malignant PVT, and the other 50 patients had HCC without malignant PVT, in the Internal Medicine department and Al-Raghy Liver Hospital between May 2016 and May 2017. Results This study showed that raised Model For End-stage Liver Disease score [odds ratio (OR)=1.34, 95% confidence interval (CI)=1.32–3.76; P = 0.02], low serum albumin (OR = 3.21, 95% CI = 2.11–3.21; P = 0.00) and raised α-fetoprotein (OR = 2.11, 95% CI = 1.09–4.11; P = 0.01) were independent predictors for malignant PVT in patients with HCC on top of liver cirrhosis. Conclusion High Model For End-stage Liver Disease score, low serum albumin and raised α-fetoprotein are major risk factors for malignant PVT in cirrhotic patients with HCC, and HCC with malignant PVT is associated with other comorbidities, high rates of hospital admission, larger tumor size and more recurrent tumors.