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J Liver Cancer > Volume 14(1); 2014 > Article
Journal of the Korean Liver Cancer Study 2014;14(1):23-30.
DOI: https://doi.org/10.17998/jlc.14.1.23    Published online March 31, 2014.
Hepatic Venous Pressure Gradient and Associated Factors in Survival Prediction in Patients with Liver Cirrhosis and Early and Very Early Hepatocellular Carcinoma
Tae Yeob Kim1, Moon Young Kim2, Jae Young Jang3, Ki Tae Suk4, Soung Won Jeong3, Dong Joon Kim4, Joo Hyun Sohn1, Soon Koo Baik2
1Department of Internal Medicine, Hanyang University Guri Hospital
2Yonsei University Wonju College of Medicine, Wonju
3Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine
4Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
Copyright ©2014 by The Korean Liver Cancer Association
Abstract
Background/Aims
To analyze the usefulness of hepatic venous pressure gradient (HVPG) in survival prediction in cirrhotic patients with early and very early hepatocellular carcinoma (HCC).
Methods
We consecutively collected data of 45 stable cirrhotic patients (male 41, median age 57.2 years, BCLC A 29) with early-stage HCC undergoing HVPG measurement. Prognostic accuracy of HVPG was analyzed by the area under curve (AUC). Survival curves and the associated factors of HVPG status were obtained using Kaplan-Meier method and logistic regression analysis, respectively.
Results
The AUC value for prediction of survival by HVPG were 0.754 (95% CI, 0.603-0.870, P=0.006). The cut-off value of HVPG to predict death was 12 mmHg. Among the 45 patients, 11 patients (24.4%) died: 11 of 28 patients in the high HVPG group and none of 17 patients in the low HVPG group during followup period (P=0.003). The survival rate with high HVPG group was higher than those of low HVPG group (log rank P=0.008). In Child-Turcott-Pugh (CTP) class, the survival rate with CTP A class was higher than that with CTP B class (log rank P<0.001). The only associated factor with HVPG ≥12 mmHg in CTP A class and early-stage HCC was the presence of medium or large sized esophageal varices (odds ratio 66.8, 95% CI, 1.3-3530.4, P=0.038).
Conclusions
HVPG ≥12 mmHg may be suggested a predictor of survival in cirrhotic patients with early-stage HCC. In CTP A class, the presence of medium or large sized esophageal varices were associated with high HVPG.
Key Words: Cirrhosis; Hepatic venous pressure gradient; Hepatocellular carcinoma; Survival; Prognosis
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