Impact and outcome of primary prophylaxis of variceal bleeding among Egyptian hepatocellular carcinoma patients with portal vein thrombosis treated with Sorafenib

Authors

1 Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Egypt.

2 Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Egypt

3 Department of Diagnostic and Intervention Radiology, National Liver Institute, Menoufia University, Egypt.

Abstract

Background: Patients with cirrhosis and hepatocellular carcinoma (HCC) experience portal hypertension, causing esophageal varices (OV). Some HCC patients taking Sorafenib experience bleeding, while others ignore this effect and believe that sorafenib might minimize bleeding. A comparison was made between carvedilol therapy and primary preventive band ligations in HCC patients with a large, risky OV and portal vein thrombosis (PVT) taking sorafenib. Survival of these patients is also analyzed. Methods: Study enrolled 120 HCC patients with PVT and large OV. They were divided into four groups: 1) Sorafenib with prophylactic band ligation, 2) Sorafenib with prophylactic carvedilol, 3) prophylactic band ligation, and 4) prophylactic carvedilol. For six months, they were followed. Primary outcomes included changes in variceal size, variceal bleeding frequency, and survival rate. Results: Baseline characteristics were not significantly different between the four groups. After preventive band ligation with or without sorafenib, variceal size declined significantly [27 (90%), 16 (53.3%), respectively; P < 0.001]. Among the four groups, variceal bleeding occurred only in [6 (20%), 5 (16.7%), 9 (30%), 4 (13.3%); P = 0.41]. Moreover, there was a significant difference in overall survival rates across the four groups [P = 0.001] with sorafenib groups had the highest survival. Whether sorafenib was used or not, the primary adverse event, a post-banding ulcer, did not significantly differ between groups I and III. Conclusion: In HCC patients with malignant PVT treated with sorafenib, prophylactic band ligation or beta-blockers had no effect on mortality or bleeding. Sorafenib treated patients have the longest survival rates

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