HCC portal hypertension imaging score derived from CT predicts re-bleeding and mortality after acute variceal bleeding

IF 3.5 2区医学 Q2 ONCOLOGY

Cancer Imaging Pub Date : 2024-03-28 DOI:10.1186/s40644-024-00689-5

Mingyuan Zhao, Binyue Zhang, Jianqiang Shi, Xiaoxian Tang, Hongxia Li, Shengwen Li, Yunfeng Yang, Yi Han, Rong Wang, Jian Xun, Kai Zhang, Xirun Wu, Jiang Zhao

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引用次数: 0

Abstract

Risk factors for re-bleeding and death after acute variceal bleeding (AVB) in cirrhotic HCC patients are not fully understood.We aimed to (1) explore how the combination of high-risk esophageal varices, HCC status, and portal vein tumor thrombus (i.e., HCC Portal Hypertension Imaging Score [HCCPHTIS]) helps predict increased risk of variceal re-bleeding and mortality; (2) assess predictability and reproducibility of the identified variceal re-bleeding rules. This prospective study included 195 HCC patients with first-time AVB and liver cirrhosis, and conducted multivariable Cox regression analysis and Kaplan-Meier analysis. Receiver operating characteristic curve analysis was calculated to find the optimal sensitivity, specificity, and cutoff values of the variables. The reproducibility of the results obtained was verified in a different but related group of patients. 56 patients (28.7%) had re-bleeding within 6 weeks; HCCPHTIS was an independent risk factor for variceal re-bleeding after AVB (Odd ratio, 2.330; 95% confidence interval: 1.728–3.142, p < 0.001). The positive predictive value of HCCPHTIS cut off value > 3 was 66.2%, sensitivity 83.9%, and specificity 82.3%. HCCPHTIS area under the curve was higher than Child-Pugh score (89% vs. 75%, p < 0.001). 74(37.9%) death occurred within 6 weeks; HCCPHTIS > 4 was associated with increased risk of death within 6 weeks after AVB (p < 0.001). HCCPHTIS > 3 is a strong predictor of variceal re-bleeding within the first 6 weeks. However, patients with HCCPHTIS > 4 were at increased risk of death within 6 weeks.

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从 CT 导出的 HCC 门脉高压成像评分可预测急性静脉曲张出血后的再出血和死亡率

我们的目的是：(1) 探讨高危食管静脉曲张、HCC 状态和门静脉肿瘤血栓（即 HCC 门静脉高压成像评分 [HCCPHTIS]）的组合如何帮助预测静脉曲张再出血和死亡率增加的风险；(2) 评估已确定的静脉曲张再出血规则的可预测性和可重复性。这项前瞻性研究纳入了 195 例首次 AVB 和肝硬化的 HCC 患者，并进行了多变量 Cox 回归分析和 Kaplan-Meier 分析。通过计算接收者操作特征曲线分析，找出变量的最佳灵敏度、特异性和截断值。在一组不同但相关的患者中验证了所得结果的可重复性。56 名患者（28.7%）在 6 周内再次出血；HCCPHTIS 是 AVB 后静脉曲张再次出血的独立风险因素（奇数比为 2.330；95% 置信区间：1.728-3.142，P 3 为 66.2%，敏感性为 83.9%，特异性为 82.3%）。HCCPHTIS 曲线下面积高于 Child-Pugh 评分（89% 对 75%，p 4 与 AVB 术后 6 周内死亡风险增加有关（p 3 是前 6 周内静脉曲张再出血的有力预测指标。然而，HCCPHTIS > 4 的患者在 6 周内死亡的风险增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Imaging ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

7.00

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Cancer Imaging is an open access, peer-reviewed journal publishing original articles, reviews and editorials written by expert international radiologists working in oncology. The journal encompasses CT, MR, PET, ultrasound, radionuclide and multimodal imaging in all kinds of malignant tumours, plus new developments, techniques and innovations. Topics of interest include: Breast Imaging Chest Complications of treatment Ear, Nose & Throat Gastrointestinal Hepatobiliary & Pancreatic Imaging biomarkers Interventional Lymphoma Measurement of tumour response Molecular functional imaging Musculoskeletal Neuro oncology Nuclear Medicine Paediatric.