Hélène Regnault1, Sheik Emambux2, Thierry Lecomte3, Solene Doat1, Marion Dhooge4, Marie Besson5, Olivier Dubreuil6, Frederic Moryoussef1, Christine Silvain7, Jean-Baptiste Bachet8, David Tougeron9. 1. Department of Hepatogastroenterology, Pitié Salpêtrière Hospital, Paris, France; Sorbonne University, UPMC University, Paris VI, France. 2. Department of Oncology, Poitiers University Hospital, Poitiers, France. 3. Department of Hepatogastroenterology and Digestive Oncology, Tours University Hospital, Tours, France; Université François-Rabelais de Tours, CNRS, GICC UMR, Tours, France. 4. Department of Gastroenterology, Cochin Hospital, Paris, France. 5. Department of Radiology, Tours University Hospital, Tours, France. 6. Sorbonne University, UPMC University, Paris VI, France. 7. Department of Gastroenterology, Poitiers University Hospital, Poitiers, France; Laboratory of Inflammation, tissus épithéliaux et cytokines (LITEC), Poitiers University, France. 8. Department of Hepatogastroenterology, Pitié Salpêtrière Hospital, Paris, France; Sorbonne University, UPMC University, Paris VI, France. Electronic address: jean-baptiste.bachet@aphp.fr. 9. Department of Oncology, Poitiers University Hospital, Poitiers, France; Department of Gastroenterology, Poitiers University Hospital, Poitiers, France; Laboratory of Inflammation, tissus épithéliaux et cytokines (LITEC), Poitiers University, France.
Abstract
INTRODUCTION: Management of portal vein thrombosis (PVT) in cancer patients remains discussed. AIMS: The objective of this multicenter retrospective study was to investigate the management and outcome of PVT in patients with digestive cancers other than hepatocellular carcinoma (HCC). METHOD: Main inclusion criteria were trunk or branch PVT in patients with locally advanced or metastatic digestive cancers. Predictive factors of bleeding and overall survival (OS) were evaluated in univariate and multivariate analysis. RESULTS: Between 2012 and 2016, 118 patients with PVT and digestive cancers were identified. The majority had a pancreatic cancer (50%). Sixty-six percent of patients had trunk PVT location. Endoscopic screening of portal hypertension was performed in only 7 patients (1%) and 5 had esophageal varices. Gastrointestinal bleeding occurred in 22 patients (19%) and 12 patient deaths (17%) were related to a gastrointestinal hemorrhage. Metastatic disease (HR=2.83 [95%CI 1.47-5.43], p<0.01) and gastrointestinal hemorrhage (HR=1.68 [95%CI 1.01-2.78], p=0.04) were associated with OS in multivariate analysis. Only trunk PVT location was significantly associated with gastrointestinal hemorrhage in multivariate analysis (HR=5.56 [95%CI 1.18-26.32], p=0.03). CONCLUSION: A high rate of variceal bleeding leading to death was found in this cohort. Endoscopic screening and the efficacy of prophylactic treatment of variceal bleeding remain to be evaluated in a prospective study.
INTRODUCTION: Management of portal vein thrombosis (PVT) in cancerpatients remains discussed. AIMS: The objective of this multicenter retrospective study was to investigate the management and outcome of PVT in patients with digestive cancers other than hepatocellular carcinoma (HCC). METHOD: Main inclusion criteria were trunk or branch PVT in patients with locally advanced or metastatic digestive cancers. Predictive factors of bleeding and overall survival (OS) were evaluated in univariate and multivariate analysis. RESULTS: Between 2012 and 2016, 118 patients with PVT and digestive cancers were identified. The majority had a pancreatic cancer (50%). Sixty-six percent of patients had trunk PVT location. Endoscopic screening of portal hypertension was performed in only 7 patients (1%) and 5 had esophageal varices. Gastrointestinal bleeding occurred in 22 patients (19%) and 12 patient deaths (17%) were related to a gastrointestinal hemorrhage. Metastatic disease (HR=2.83 [95%CI 1.47-5.43], p<0.01) and gastrointestinal hemorrhage (HR=1.68 [95%CI 1.01-2.78], p=0.04) were associated with OS in multivariate analysis. Only trunk PVT location was significantly associated with gastrointestinal hemorrhage in multivariate analysis (HR=5.56 [95%CI 1.18-26.32], p=0.03). CONCLUSION: A high rate of variceal bleeding leading to death was found in this cohort. Endoscopic screening and the efficacy of prophylactic treatment of variceal bleeding remain to be evaluated in a prospective study.
Authors: Tom Luedde; Jonel Trebicka; Frank Erhard Uschner; Florian Schueller; Ivelina Nikolova; Sabine Klein; Robert Schierwagen; Fernando Magdaleno; Stefanie Gröschl; Sven Loosen; Thomas Ritz; Christoph Roderburg; Michael Vucur; Glen Kristiansen; Twan Lammers Journal: Oncotarget Date: 2018-11-16