Determinants of esophageal varices bleeding in patients with advanced hepatocellular carcinoma treated with sorafenib

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Abstract

Background and aims: Sorafenib is the standard of care for patients with advanced hepatocellular carcinoma (HCC), yet treatment safety may be challenged by portal hypertension. We therefore assessed the prevalence, risk factors and clinical consequences of esophageal varices (EVs) in sorafenib-treated patients with HCC. Methods: Starting in 2008, all compensated patients with advanced or intermediate HCC not eligible for other therapies were consecutively enrolled in a prospective evaluation of sorafenib therapy, all with pretreatment by upper-gastrointestinal endoscopy (UGE). Results: A total of 150 patients received sorafenib for 4.6 (95% CI, 3.3–5.6) months. At baseline, 61 (41%) patients were EV free (group A), 78 (52%) had EVs (61 small EVs (group B), 17 medium/large EVs (group C)) and 11 (7%) previously endoscopically treated EVs (group D). Propranolol was given to all patients with medium/large EVs and those with previous bleeding. Twelve patients (8%) bled from EVs after 36 (18–260) days of sorafenib. During sorafenib, bleeding occurred in six of 26 group B patients with neoplastic portal vein thrombosis (nPVT), three of nine group C patients with nPVT, two of five group D patients with nPVT and one of six without nPVT (p < 0.0001), nPVT being the strongest independent predictor of bleeding by multivariate analysis (HR = 15.4, 95% CI 1.84–129.6). Conclusion: UGE screening is worthwhile in HCC patients allocated to sorafenib since it identifies patients with EVs at risk of bleeding during therapy, particularly those with nPVT.

Original languageEnglish
Pages (from-to)363-370
Number of pages8
JournalUnited European Gastroenterology Journal
Volume4
Issue number3
DOIs
Publication statusPublished - Jun 1 2016

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Esophageal and Gastric Varices
Hepatocellular Carcinoma
Hemorrhage
Portal Vein
Thrombosis
Gastrointestinal Endoscopy
sorafenib
Portal Hypertension
Therapeutics
Standard of Care
Propranolol
Multivariate Analysis

Keywords

  • cirrhosis
  • Hepatocellular carcinoma
  • portal hypertension
  • portal vein thrombosis
  • upper gastrointestinal endoscopy
  • varices

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

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title = "Determinants of esophageal varices bleeding in patients with advanced hepatocellular carcinoma treated with sorafenib",
abstract = "Background and aims: Sorafenib is the standard of care for patients with advanced hepatocellular carcinoma (HCC), yet treatment safety may be challenged by portal hypertension. We therefore assessed the prevalence, risk factors and clinical consequences of esophageal varices (EVs) in sorafenib-treated patients with HCC. Methods: Starting in 2008, all compensated patients with advanced or intermediate HCC not eligible for other therapies were consecutively enrolled in a prospective evaluation of sorafenib therapy, all with pretreatment by upper-gastrointestinal endoscopy (UGE). Results: A total of 150 patients received sorafenib for 4.6 (95{\%} CI, 3.3–5.6) months. At baseline, 61 (41{\%}) patients were EV free (group A), 78 (52{\%}) had EVs (61 small EVs (group B), 17 medium/large EVs (group C)) and 11 (7{\%}) previously endoscopically treated EVs (group D). Propranolol was given to all patients with medium/large EVs and those with previous bleeding. Twelve patients (8{\%}) bled from EVs after 36 (18–260) days of sorafenib. During sorafenib, bleeding occurred in six of 26 group B patients with neoplastic portal vein thrombosis (nPVT), three of nine group C patients with nPVT, two of five group D patients with nPVT and one of six without nPVT (p < 0.0001), nPVT being the strongest independent predictor of bleeding by multivariate analysis (HR = 15.4, 95{\%} CI 1.84–129.6). Conclusion: UGE screening is worthwhile in HCC patients allocated to sorafenib since it identifies patients with EVs at risk of bleeding during therapy, particularly those with nPVT.",
keywords = "cirrhosis, Hepatocellular carcinoma, portal hypertension, portal vein thrombosis, upper gastrointestinal endoscopy, varices",
author = "Massimo Iavarone and Massimo Primignani and Sara Vavassori and Angelo Sangiovanni and {La Mura}, Vincenzo and Raffaella Romeo and Massimo Colombo",
year = "2016",
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pages = "363--370",
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TY - JOUR

T1 - Determinants of esophageal varices bleeding in patients with advanced hepatocellular carcinoma treated with sorafenib

AU - Iavarone, Massimo

AU - Primignani, Massimo

AU - Vavassori, Sara

AU - Sangiovanni, Angelo

AU - La Mura, Vincenzo

AU - Romeo, Raffaella

AU - Colombo, Massimo

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Background and aims: Sorafenib is the standard of care for patients with advanced hepatocellular carcinoma (HCC), yet treatment safety may be challenged by portal hypertension. We therefore assessed the prevalence, risk factors and clinical consequences of esophageal varices (EVs) in sorafenib-treated patients with HCC. Methods: Starting in 2008, all compensated patients with advanced or intermediate HCC not eligible for other therapies were consecutively enrolled in a prospective evaluation of sorafenib therapy, all with pretreatment by upper-gastrointestinal endoscopy (UGE). Results: A total of 150 patients received sorafenib for 4.6 (95% CI, 3.3–5.6) months. At baseline, 61 (41%) patients were EV free (group A), 78 (52%) had EVs (61 small EVs (group B), 17 medium/large EVs (group C)) and 11 (7%) previously endoscopically treated EVs (group D). Propranolol was given to all patients with medium/large EVs and those with previous bleeding. Twelve patients (8%) bled from EVs after 36 (18–260) days of sorafenib. During sorafenib, bleeding occurred in six of 26 group B patients with neoplastic portal vein thrombosis (nPVT), three of nine group C patients with nPVT, two of five group D patients with nPVT and one of six without nPVT (p < 0.0001), nPVT being the strongest independent predictor of bleeding by multivariate analysis (HR = 15.4, 95% CI 1.84–129.6). Conclusion: UGE screening is worthwhile in HCC patients allocated to sorafenib since it identifies patients with EVs at risk of bleeding during therapy, particularly those with nPVT.

AB - Background and aims: Sorafenib is the standard of care for patients with advanced hepatocellular carcinoma (HCC), yet treatment safety may be challenged by portal hypertension. We therefore assessed the prevalence, risk factors and clinical consequences of esophageal varices (EVs) in sorafenib-treated patients with HCC. Methods: Starting in 2008, all compensated patients with advanced or intermediate HCC not eligible for other therapies were consecutively enrolled in a prospective evaluation of sorafenib therapy, all with pretreatment by upper-gastrointestinal endoscopy (UGE). Results: A total of 150 patients received sorafenib for 4.6 (95% CI, 3.3–5.6) months. At baseline, 61 (41%) patients were EV free (group A), 78 (52%) had EVs (61 small EVs (group B), 17 medium/large EVs (group C)) and 11 (7%) previously endoscopically treated EVs (group D). Propranolol was given to all patients with medium/large EVs and those with previous bleeding. Twelve patients (8%) bled from EVs after 36 (18–260) days of sorafenib. During sorafenib, bleeding occurred in six of 26 group B patients with neoplastic portal vein thrombosis (nPVT), three of nine group C patients with nPVT, two of five group D patients with nPVT and one of six without nPVT (p < 0.0001), nPVT being the strongest independent predictor of bleeding by multivariate analysis (HR = 15.4, 95% CI 1.84–129.6). Conclusion: UGE screening is worthwhile in HCC patients allocated to sorafenib since it identifies patients with EVs at risk of bleeding during therapy, particularly those with nPVT.

KW - cirrhosis

KW - Hepatocellular carcinoma

KW - portal hypertension

KW - portal vein thrombosis

KW - upper gastrointestinal endoscopy

KW - varices

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U2 - 10.1177/2050640615615041

DO - 10.1177/2050640615615041

M3 - Article

VL - 4

SP - 363

EP - 370

JO - United European Gastroenterology Journal

JF - United European Gastroenterology Journal

SN - 2050-6406

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