Baveno VII Criteria Is an Accurate Risk Stratification Tool to Predict High-Risk Varices Requiring Intervention and Hepatic Events in Patients with Advanced Hepatocellular Carcinoma
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design Overview and Subjects
2.2. Clinical and Laboratory Evaluation
2.3. Transient Elastography Examination
2.4. Upper Endoscopy
2.5. Systemic Therapies for HCC
2.6. Clinical Assessments during Follow-Up
2.7. Clinical Outcomes
2.8. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Liver Stiffness Measurement
3.3. Baveno Criteria and Other Combinations of LSM and PLT
3.4. Varices in Patients Who Did or Did Not Receive Systemic Therapies
3.5. VNT and Baveno VII Criteria
3.6. Hepatic Events and Baveno VII Criteria
3.7. Predictors of VNT and Hepatic Events
4. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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All Patients N = 200 | Systemic Therapies N = 76 | No Systemic Therapies N = 124 | p-Value | |
---|---|---|---|---|
Follow-up duration (months) | 11.9 (4.6–39.6) | 8.5 (4.7–21.3) | 15.6 (4.5–42.2) | 0.066 |
Male gender | 161 (80.5%) | 64 (84.2%) | 97 (78.2%) | 0.3 |
Age (year) | 61.3 (11.3) | 58.0 (10.4) | 63.4 (11.3) | <0.001 |
Chronic hepatitis B | 139 (69.5%) | 54 (71.1%) | 85 (68.5%) | 0.709 |
Chronic hepatitis C | 15 (7.5%) | 7 (9.2%) | 8 (6.5%) | 0.472 |
Platelet (×109/L) | 204.1 (113.6) | 214.2 (117.9) | 197.9 (110.8) | 0.328 |
≥150 × 109/L | 125 (62.5%) | 53 (69.7%) | 72 (58.1%) | 0.098 |
≥110 × 109/L | 159 (79.5%) | 64 (84.2%) | 95 (76.6%) | 0.196 |
Prothrombin time (s) | 11.9 (1.6) | 11.9 (1.0) | 12.0 (1.9) | 0.738 |
Creatinine (μmol/L) | 82.9 (31.2) | 80.8 (38.4) | 84.2 (26.0) | 0.455 |
Albumin (g/l) | 37.0 (5.3) | 37.3 (5.1) | 36.9 (5.4) | 0.574 |
Total bilirubin (μmol/L) | 20.4 (16.2) | 19.3 (13.2) | 20.9 (17.8) | 0.626 |
ALT (IU/L) | ||||
Median (IQR) | 45 (32–67) | 42 (33.5–52.5) | 46.5 (30.5–75) | 0.160 |
AFP (μg/L) | ||||
Median (IQR) | 213 (11–7757) | 1526 (22–44,248) | 56 (7.5–2085) | 0.005 |
CTP grade | ||||
A | 135 (67.5%) | 54 (71.1%) | 81 (65.3%) | 0.401 |
B | 64 (32.0%) | 22 (28.9%) | 42 (33.9%) | 0.469 |
C | 1 (0.5%) | 1 (0.8%) | 0 (0%) | 1.000 |
CTP score | 6 (5–7) | 6 (5–7) | 6 (5–7) | 0.272 |
BCLC | ||||
A | 25 (12.5%) | 7 (9.2%) | 18 (14.5%) | 0.271 |
Fulfil Baveno criteria (n = 41) | 3 (7.3%) | 1 (7.7%) | 2 (7.1%) | 1.000 |
Not fulfil Baveno criteria (n = 159) | 22 (13.8%) | 6 (9.5%) | 16 (16.7%) | 0.202 |
B | 51 (25.5%) | 19 (25%) | 32 (25.8%) | 0.899 |
Fulfil Baveno criteria (n = 41) | 14 (34.1%) | 3 (23.1%) | 11 (39.3%) | 0.481 |
Not fulfil Baveno criteria (n = 159) | 37 (23.3%) | 16 (25.4%) | 21 (21.9%) | 0.607 |
C | 124 (62%) | 50 (65.8%) | 74 (59.7%) | 0.387 |
Fulfil Baveno criteria (n = 41) | 24 (58.5%) | 9 (69.2%) | 15 (53.6%) | 0.344 |
Not fulfil Baveno criteria (n = 159) | 100 (62.9%) | 41 (65.1%) | 59 (61.5%) | 0.644 |
Combination with immunotherapy | 3 (1.5%) | 3 (3.9%) | 0 (0%) | 0.054 |
LSM (kPa) Missing (%) | 25.4 (11.9–66.8) 12% | 32.4 (16.5–69.1) 14.5% | 21.8 (11.1–65.2) 10.5% | 0.117 |
IQR/LSM (%) Missing (%) | 15.2 (7.3–22.6) 21.2% | 14.2 (7.7–22.8) 23.7% | 15.5 (7.2–21.7) 20.2% | 0.850 |
With right-sided involvement (n = 91) | 17.2 (10–46.7) | 19.4 (9.0–24.7) | 16.5 (10.0–56.9) | 0.457 |
IQR/LSM (%) Missing (%) | 16.4 (9.4–22.4) 24.2% | 16.9(13.9–22.9) 34.6% | 16.4 (8.0–21.3) 20% | 0.419 |
Without right-sided involvement (n = 109) | 35.8 (14.1–75) | 48.4 (24.8–75) | 24.6 (13.5–75) | 0.087 |
IQR/LSM (%) Missing (%) | 14.0 (5.4–22.6) 19.3% | 13.5 (0–22.7) 18% | 14.4 (6.4–21.7) 20.3 | 0.641 |
≤15 kPa | 60 (30%) | 16 (21.1%) | 44 (35.5%) | 0.042 |
≤20 kPa | 73 (36.5%) | 21 (27.6%) | 52 (41.9%) | 0.059 |
≤25 kPa | 88 (44%) | 27 (35.5%) | 61 (49.2%) | 0.086 |
LSM and platelet criteria | ||||
LSM ≤ 15 kPa and PLT > 150 × 109/L | 37 (18.5%) | 12 (15.8%) | 25 (20.2%) | 0.440 |
LSM ≤ 15 kPa and PLT > 110 × 109/L | 47 (23.5%) | 14 (18.2%) | 34 (27.0%) | 0.185 |
LSM ≤ 20 kPa and PLT > 150 × 109/L | 41 (20.5%) | 13 (17.1%) | 28 (22.6%) | 0.352 |
LSM ≤ 20 kPa and PLT > 110 × 109/L | 54 (27%) | 15 (19.7%) | 39 (31.5%) | 0.07 |
LSM ≤ 25 kPa and PLT > 150 × 109/L | 53 (26.5%) | 17 (22.4%) | 36 (29.0%) | 0.3 |
LSM ≤ 25 kPa and PLT > 110 × 109/L | 67 (33.5%) | 20 (26.3%) | 47 (37.9%) | 0.092 |
All Patients N = 200 | Systemic Therapies N = 76 | No Systemic Therapies N = 124 | p-Value | |
---|---|---|---|---|
Any varices | 50 (25%) | 18 (23.7%) | 32 (25.8%) | 0.737 |
Oesophageal varices | 48 (24%) | 18 (23.7%) | 30 (24.2%) | 0.935 |
Gastric varices | 4 (2%) | 2 (2.6%) | 2 (1.6%) | 0.626 |
Acute variceal bleeding (AVB) | 11 (5.5%) | 3 (3.9%) | 8 (6.5%) | 0.353 |
Bleeding oesophageal varices | 8 (3.5%) | 1 (1.3%) | 7 (5.6%) | 0.138 |
Bleeding gastric varices | 3 (1.5%) | 2 (2.6%) | 1 (0.8%) | 0.559 |
Endoscopic therapy | 22 (11%) | 9 (11.8%) | 13 (10.5%) | 0.766 |
Varices needing treatment (VNT) | 45 (22.5%) | 15 (19.7%) | 30 (24.2%) | 0.464 |
Fulfil Baveno criteria (n = 41) | 7 (17.1%) | 2 (15.4%) | 5 (15.4%) | 1.000 |
Not fulfil Baveno criteria (n = 159) | 38 (23.9%) | 13 (20.6%) | 25 (26.0%) | 0.434 |
CTP grade for VNT | ||||
A | 24 (12%) | 10 (13.2%) | 14 (11.3%) | 0.693 |
B | 21 (10.5%) | 5 (6.6%) | 16 (12.9%) | 0.157 |
BCLC | ||||
A | 8 (4%) | 2 (2.6%) | 6 (4.8%) | 0.712 |
B | 16 (8%) | 6 (7.9%) | 10 (8.1%) | 0.966 |
C | 21 (10.5%) | 7 (9.2%) | 14 (11.3%) | 0.641 |
Portal vein thrombosis (PVT) ** | 75 (37.5%) | 36 (47.4%) | 39 (31.5%) | 0.024 |
VNT in those with PVT (n = 75) | 12 (16.0%) | 7 (19.4%) | 5 (12.8%) | 0.434 |
Bleeding risk | 4 (5.3%) | 1 (2.8%) | 3 (7.7%) | 0.616 |
Without PVT | 125 (62.5%) | 40 (52.6%) | 85 (68.5%) | 0.024 |
VNT in those without PVT (n = 125) | 33 (26.4%) | 8 (20%) | 25 (29.4%) | 0.265 |
Bleeding risk | 6 (4.8%) | 2 (5%) | 4 (4.7%) | 1.000 |
VNT in following subgroups | ||||
LSM ≤ 15 kPa and PLT ≥ 150 × 109/L | 6 (3%) | 2 (2.6%) | 4 (3.2%) | 1.000 |
LSM ≤ 15 kPa and PLT ≥ 110 × 109/L | 9 (4.5%) | 3 (3.9%) | 6 (4.8%) | 1.000 |
LSM ≤ 20 kPa and PLT ≥ 150 × 109/L | 7 (3.5%) | 2 (2.6%) | 5 (4.0%) | 1.000 |
LSM ≤ 20 kPa and PLT ≥ 110 × 109/L | 10 (5%) | 3 (3.9%) | 7 (5.6%) | 0.745 |
LSM ≤ 25 kPa and PLT ≥ 150 × 109/L | 7 (3.5%) | 2 (2.6%) | 5 (4.0%) | 0.711 |
LSM ≤ 25 kPa and PLT ≥ 110 × 109/L | 11 (5.5%) | 4 (5.3%) | 7 (5.6%) | 1.000 |
Time to VNT (months) | 11.3 (3.9–37.4) | 7.9 (4.2–21.1) | 15.4 (3.8–41.8) | 0.067 |
All Patients N = 200 | Systemic Therapies N = 76 | No Systemic Therapies N = 124 | p-Value | |
---|---|---|---|---|
Any hepatic events * | 56 (28%) | 18 (23.7%) | 38 (30.6%) | 0.287 |
Acute variceal bleed (AVB) ^ | 11 (5.5%) | 3 (3.9%) | 8 (6.5%) | 0.353 |
Ascites ^ | 44 (22%) | 13 (17.1%) | 31 (25%) | 0.191 |
Spontaneous bacterial peritonitis (SBP) ^ | 4 (2%) | 0 (0%) | 4 (3.2%) | 0.300 |
Hepatic encephalopathy (HE) ^ | 17 (8.5%) | 5 (6.6%) | 12 (9.7%) | 0.446 |
Hepatorenal syndrome (HRS) ^ | 6 (3%) | 1 (1.3%) | 5 (4.0%) | 0.411 |
Liver-related death | 128 (64%) | 54 (71.1%) | 74 (59.7%) | 0.104 |
Fulfil Baveno criteria (n = 41) | 16 (39.0%) | 7 (53.8%) | 9 (32.1%) | 0.185 |
Not fulfil Baveno criteria (n = 159) | 112 (70.4%) | 47 (74.6%) | 65 (67.7%) | 0.351 |
Hepatic events in following subgroups | ||||
LSM ≤ 15 kPa and PLT ≥ 150 × 109/L | 4 (2%) | 1 (1.3%) | 3 (2.4%) | 1.000 |
LSM ≤ 15 kPa and PLT ≥ 110 × 109/L | 8 (4%) | 1 (1.3%) | 7 (5.6%) | 0.159 |
LSM ≤ 20 kPa and PLT ≥ 150 × 109/L | 6 (3%) | 1 (1.3%) | 5 (4.0%) | 0.411 |
LSM ≤ 20 kPa and PLT ≥ 110 × 109/L | 10 (5%) | 1 (1.3%) | 9 (7.3%) | 0.093 |
LSM ≤ 25 kPa and PLT ≥ 150 × 109/L | 7 (3.5%) | 2 (2.6%) | 5 (4.0%) | 0.711 |
LSM ≤ 25 kPa and PLT ≥ 110 × 109/L | 12 (6%) | 3 (3.9%) | 9 (7.3%) | 0.541 |
LSM > 25 kPa | 28 (14%) | 10 (13.2%) | 18 (14.5%) | 0.786 |
Fulfil Baveno criteria (n =41) | 6 (14.6%) | 1 (7.7%) | 5 (17.9%) | 0.645 |
Not fulfil Baveno criteria (n = 159) | 50 (31.4%) | 17 (27.0%) | 33 (34.4%) | 0.326 |
Parameters | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
SHR (95% CI) | p-Value | Adjusted SHR (95% CI) | p-Value | |
Use of systemic therapy | 0.81 (0.44–1.49) | 0.508 | 1.01 (0.41–2.45) | 0.989 |
Age | 0.99 (0.97–1.01) | 0.373 | 0.97 (0.94–1.01) | 0.125 |
Male gender | 1.76 (0.79–3.95) | 0.168 | 1.58 (0.79–3.18) | 0.198 |
| ||||
| Referent | Referent | ||
| 0.97 (0.44–2.14) | 0.945 | 1.17 (0.58–2.38) | 0.663 |
| 0.48 (0.22–1.03) | 0.059 | 0.87 (0.39–1.90) | 0.718 |
| ||||
| Referent | Referent | ||
| 0.63 (0.30–1.32) | 0.224 | 0.83 (0.38–1.83) | 0.646 |
Presence of PVT | 0.55 (0.29–1.03) | 0.064 | 0.77 (0.34–1.77) | 0.542 |
Previous hepatectomy or TACE | 1.35 (0.62–2.95) | 0.451 | 0.70 (0.21–2.30) | 0.555 |
LSM | 0.99 (0.98–1.00) | 0.128 | 1.00 (0.98–1.01) | 0.852 |
Platelet | 0.99 (0.99–0.99) | <0.001 | 0.99 (0.98–1.00) | 0.001 |
Baveno criteria | 0.72 (0.33–1.59) | 0.418 | 1.14 (0.33–3.97) | 0.842 |
Parameters | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
SHR (95% CI) | p-Value | Adjusted SHR (95% CI) | p-Value | |
Use of systemic therapy | 0.76 (0.44–1.33) | 0.333 | 1.13 (0.55–2.34) | 0.731 |
Age | 1.02 (0.99–1.04) | 0.2 | 1.01 (0.97–1.04) | 0.672 |
Male gender | 1.00 (0.52–1.90) | 0.992 | 1.21 (0.62–2.38) | 0.57 |
| ||||
| Referent | Referent | ||
| 0.90 (0.39–2.11) | 0.815 | 1.14 (0.48–2.71) | 0.769 |
| 0.78 (0.37–1.67) | 0.525 | 1.13 (0.47–2.68) | 0.785 |
| ||||
| Referent | Referent | ||
| 1.46 (0.83–2.55) | 0.187 | 1.48 (0.75–2.91) | 0.261 |
Presence of PVT | 0.81 (0.47–1.39) | 0.448 | 0.83 (0.42–1.64) | 0.589 |
previous hepatectomy or TACE | 0.61 (0.26–1.45) | 0.264 | 0.48 (0.15–1.48) | 0.199 |
LSM | 1.00 (0.99–1.01) | 0.668 | 1.01 (0.99–1.02) | 0.349 |
Platelet | 0.99 (0.99–1.00) | 0.004 | 0.99 (0.99–1.00) | 0.005 |
Baveno criteria | 0.41 (0.18–0.94) | 0.036 | 0.78 (0.26–2.33) | 0.65 |
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Share and Cite
Wu, C.W.-K.; Lui, R.N.-S.; Wong, V.W.-S.; Yam, T.-F.; Yip, T.C.-F.; Liu, K.; Lai, J.C.-T.; Tse, Y.-K.; Mok, T.S.-K.; Chan, H.L.-Y.; et al. Baveno VII Criteria Is an Accurate Risk Stratification Tool to Predict High-Risk Varices Requiring Intervention and Hepatic Events in Patients with Advanced Hepatocellular Carcinoma. Cancers 2023, 15, 2480. https://doi.org/10.3390/cancers15092480
Wu CW-K, Lui RN-S, Wong VW-S, Yam T-F, Yip TC-F, Liu K, Lai JC-T, Tse Y-K, Mok TS-K, Chan HL-Y, et al. Baveno VII Criteria Is an Accurate Risk Stratification Tool to Predict High-Risk Varices Requiring Intervention and Hepatic Events in Patients with Advanced Hepatocellular Carcinoma. Cancers. 2023; 15(9):2480. https://doi.org/10.3390/cancers15092480
Chicago/Turabian StyleWu, Claudia Wing-Kwan, Rashid Nok-Shun Lui, Vincent Wai-Sun Wong, Tsz-Fai Yam, Terry Cheuk-Fung Yip, Ken Liu, Jimmy Che-To Lai, Yee-Kit Tse, Tony Shu-Kam Mok, Henry Lik-Yuen Chan, and et al. 2023. "Baveno VII Criteria Is an Accurate Risk Stratification Tool to Predict High-Risk Varices Requiring Intervention and Hepatic Events in Patients with Advanced Hepatocellular Carcinoma" Cancers 15, no. 9: 2480. https://doi.org/10.3390/cancers15092480