Incidence and predictors of esophagogastric varices bleeding in patients with hepatocellular carcinoma in lenvatinib

被引：3

作者：

Iavarone, Massimo ^{[1
]}

Alimenti, Eleonora ^{[2
]}

Tada, Toshifumi ^{[3
]}

Shimose, Shigeo ^{[4
]}

Suda, Goki ^{[5
]}

Yoo, Changhoon ^{[6
]}

Solda, Caterina ^{[7
]}

Piscaglia, Fabio ^{[8
]}

Tosetti, Giulia ^{[1
]}

Marra, Fabio ^{[9
]}

Vivaldi, Caterina ^{[10
,11
]}

Conti, Fabio ^{[12
]}

Schirripa, Marta ^{[13
]}

Iwamoto, Hideki ^{[4
]}

Sho, Takuya ^{[5
]}

Lee, So Heun ^{[6
]}

Rizzato, Mario Domenico ^{[14
]}

Tonnini, Matteo ^{[15
]}

Rimini, Margherita ^{[16
]}

Campani, Claudia ^{[9
]}

Masi, Gianluca ^{[10
,11
]}

Foschi, Francesco ^{[12
]}

Bruccoleri, Mariangela ^{[1
]}

Kawaguchi, Takumi ^{[4
]}

Kumada, Takashi ^{[17
]}

Hiraoka, Atsushi ^{[18
]}

Atsukawa, Masanori ^{[19
]}

Fukunishi, Shinya ^{[20
]}

Ishikawa, Toru ^{[21
]}

Tajiri, Kazuto ^{[22
]}

Ochi, Hironori ^{[23
]}

Yasuda, Satoshi ^{[24
]}

Toyoda, Hidenori ^{[24
]}

Hatanaka, Takeshi ^{[25
]}

Kakizaki, Satoru ^{[26
]}

Kawata, Kazuhito ^{[27
]}

Tada, Fujimasa ^{[28
]}

Ohama, Hideko ^{[18
]}

Itokawa, Norio ^{[19
]}

Okubo, Tomomi ^{[19
]}

Arai, Taeang ^{[19
]}

Imai, Michitaka ^{[21
]}

Naganuma, Atsushi ^{[28
]}

Casadei-Gardini, Andrea ^{[16
]}

Lampertico, Pietro ^{[1
,29
]}

机构：

[1] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Div Gastroenterol & Hepatol, Via F Sforza 28, I-20122 Milan, Italy

[2] Univ Pavia, Dept Med Sci, Pavia, Italy

[3] Japanese Red Cross Himeji Hosp, Dept Internal Med, Himeji, Japan

[4] Kurume Univ, Dept Med, Div Gastroenterol, Sch Med, Kurume, Fukuoka, Japan

[5] Hokkaido Univ, Dept Gastroenterol & Hepatol, Grad Sch Med, Sapporo, Hokkaido, Japan

[6] Univ Ulsan, Asan Med Ctr, Dept Oncol, Coll Med, Seoul, South Korea

[7] Veneto Inst Oncol IOV IRCCS, Med Oncol 1, Padua, Italy

[8] IRCCS Azienda Osped Univ Bologna, Div Internal Med Hepatobiliary & Immunoallerg Dis, Bologna, Italy

[9] Univ Firenze, Dipartimento Med Sperimentale & Clin, Florence, Italy

[10] Univ Pisa, Dept Translat Res & New Technol Med, Pisa, Italy

[11] Azienda Osped Univ Pisana, Unit Med Oncol 2, Pisa, Italy

[12] AUSL Romagna, Med Interna Faenza, Ravenna, Italy

[13] Cent Hosp Belcolle, Dept Oncol & Hematol, Med Oncol Unit, Viterbo, Italy

[14] Univ Padua, Dept Surg Oncol & Gastroenterol Sci, Padua, Italy

[15] Univ Bologna, Dept Med & Surg Sci, Bologna, Italy

[16] Univ Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst Hosp, Dept Oncol, Milan, Italy

[17] Gifu Kyoritsu Univ, Dept Nursing, Ogaki, Japan

[18] Ehime Prefectural Cent Hosp, Gastroenterol Ctr, Matsuyama, Japan

[19] Nippon Med Sch, Dept Internal Med, Div Gastroenterol & Hepatol, Tokyo, Japan

[20] Osaka Med & Pharmaceut Univ, Dept Gastroenterol, Osaka, Japan

[21] Saiseikai Niigata Hosp, Dept Gastroenterol, Niigata, Japan

[22] Toyama Univ Hosp, Dept Gastroenterol, Toyama, Japan

[23] Japanese Red Cross Matsuyama Hosp, Hepatobiliary Ctr, Matsuyama, Japan

[24] Ogaki Municipal Hosp, Dept Gastroenterol & Hepatol, Ogaki, Japan

[25] Gunma Saiseikai Maebashi Hosp, Dept Gastroenterol, Maebashi, Japan

[26] Natl Hosp Org Takasaki Gen Med Ctr, Dept Clin Res, Takasaki, Japan

[27] Hamamatsu Univ Sch Med, Dept Hepatol, Hamamatsu, Japan

[28] Natl Hosp Org Takasaki Gen Med Ctr, Dept Gastroenterol, Takasaki, Japan

[29] Univ Milan, CRC AM & A Migliavacca Ctr Liver Dis, Dept Pathophysiol & Transplantat, Milan, Italy

来源：

LIVER CANCER | 2024年 / 13卷 / 02期

关键词：

cirrhosis; portal hypertension; varices; neoplastic portal vein thrombosis; bevacizumab; ATEZOLIZUMAB PLUS BEVACIZUMAB; ESOPHAGEAL-VARICES; CHILD-PUGH; SORAFENIB; CIRRHOSIS;

D O I：

10.1159/000534127

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Introduction: Lenvatinib is indicated for the forefront treatment of advanced hepatocellular carcinoma (aHCC), but its use maybe limited by the risk of esophagogastric varices (EGV) bleeding. This study assessed the prevalence, predictors, and complications of EGV in aHCC patients treated with lenvatinib.Methods: In this multicenter international retrospective study, cirrhotic patients treated with lenvatinib for aHCC, were enrolled if upper-gastrointestinal endoscopy (UGE) available within 6 months before treatment. Primary endpoint was the incidence of EGV bleeding during lenvatinib therapy; secondary endpoints were predictors for EGV bleeding, prevalence and risk factors for the presence of EGV and high risk EGV at baseline, impact of EGV bleeding on patients survival.Results: 535 patients were enrolled in the study [median age 72 years, 78% male, 63% viral aetiology, 89% Child-Pugh A, 16% neoplastic portal vein thrombosis (nPVT), 56% BCLC-C]: 234 had EGV (44%): 70 (30%) at high-risk and 59 on primary prophylaxis. During lenvatinib treatment, 17 patients bled from EGV (3 grade 5), the 12-month cumulative incidence being 3%. The only baseline independent predictor of EGV bleeding was the presence of baseline high risk EGV (HR 6.94, 95% CI 2.23-21.57, p=0.001). In these patients the 12-month risk was 17%. High risk varices were independently associated with Child-Pugh B score (OR 2.12; 95%CI 1.08-4.17, p=0.03), nPVT (OR 2.54; 95%CI 1.40-4.61, p=0.002) and platelets < 150.000/uL (OR 2.47; 95%CI 1.35-4.50, p=0.003.Conclusion: In HCC patients treated with lenvatinib, the risk of EGV bleeding was mostly low but significant only in patients with high-risk EGV at baseline.

引用

页码：215 / 226

页数：12

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