Hepatic Venous Pressure Gradient and Associated Factors in Survival Prediction in Patients with Liver Cirrhosis and Early and Very Early Hepatocellular Carcinoma

Kim, Tae Yeob; Kim, Moon Young; Jang, Jae Young; Suk, Ki Tae; Jeong, Soung Won; Kim, Dong Joon; Sohn, Joo Hyun; Baik, Soon Koo

doi:2014.14.1.23

J Liver Cancer > Volume 14(1); 2014 > Article

Original 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

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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