Screening and management of portal hypertension in advanced hepatocellular carcinoma: A French practice survey - 02/02/23
, Sylvain Manfredi b, Léa Lerosey b, Nathalie Ganne-Carrié c, d, Dominique Thabut a, eHighlights |
• | In patients with advanced hepatocellular carcinoma, portal hypertension is assessed by endoscopy in 80.0%. |
• | Acute variceal bleeding primary prophylaxis for large size esophageal varices in patients with advanced hepatocellular carcinoma is impacted by the presence of red marks at endoscopy. |
• | In case of advanced hepatocellular carcinoma, the initiation of a systemic treatment (Both Atezolizumab-Bevacizumab and tyrosine kinase inhibitors) is lower in patients with an history of AVB < 6 months. |
• | Strategies for screening and management of portal hypertension in advanced hepatocellular carcinoma remain very heterogeneous among physicians, suggesting the need to improve portal hypertension knowledge and dedicated studies for advanced hepatocellular carcinoma. |
Abstract |
Background |
Portal hypertension (PHT) and hepatocellular carcinoma (HCC) are two major complications of cirrhosis that are closely linked and impact patients prognosis, particularly acute variceal bleeding (AVB). Therefore, PHT screening and AVB prophylaxis are major issues to improve the outcome of the patients, but practices may vary among physicians.
Methods |
We submitted hepatologists, gastroenterologists and digestive oncologists to a questionnaire of 70 items about PHT screening and management to evaluate their practice.
Results |
95 out of 847 physicians responded to the questionnaire (hepatologists 63.2%, Oncologists/gastroenterologists 36.8%). In patients with advanced HCC, PHT was assessed by endoscopy in 80.0% of cases. HCC progression motivated a new for 12.6% of respondents while no intent to control was declared for 49.5% of them.
AVB primary prophylaxis for large size esophageal varices (EV) was impacted by the presence of red marks at endoscopy. In the absence of a red mark, prophylaxis with non-selective betablockers (NSSB) was proposed in 70.5% of cases for patients undergoing TKI and 63.2% undergoing Atezolizumab/Bevacizumab, whereas the combination of endoscopic band ligation (EBL) and NSBB was preferred in 41.1% of patients undergoing TKI versus 53.7% undergoing Atezolizumab/Bevacizumab in case of a red mark.
The initiation of a systemic treatment was lower in patients with an history of AVB <6 months, which was even more significant for Atezolizumab/Bevacizumab combination (51.6%) compared to tyrosine kinase inhibitors (72.6%) (p<0.001). Atezolizumab/Bevacizumab was initiated in 43% of participants in case of AVB <6 months versus 95% if >6 months (p<0.001).
In case of AVB on Atezolizumab/Bevacizumab, 43.2% continued the treatment after regression of EV, 24.2% continued Atezolizumab alone and 14.7% permanently stopped the treatment.
Conclusion |
Strategies for screening and management of PHT in advanced HCC remain very heterogeneous among physicians, suggesting the need to improve PHT knowledge and dedicated studies for advanced HCC.
El texto completo de este artículo está disponible en PDF.Keywords : Hepatocellular carcinoma, Portal hypertension, Prophylaxis
Abbreviations : AFEF, AVB, CSPH, EBL, EV, FFCD, HCC, LSM, NSSB, OS, PHT, Plt, TACE, TIPS, TKI, VEGF
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Vol 47 - N° 2
Artículo 102059- février 2023 Regresar al número
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