Macrovascular Malignant Portal Vein Thrombosis in Cirrhotic Patients with HCC

1.1. Background: The presence of macrovascular malignant portal vein thrombosis (MMPVT) in patients with HCC is one of the most significant prognostic factors. Without treatment, the survival is less than 3 months [1]. Standard treatment regimens have not been established in these patients. 1.2. Aims: Our aim was to explore the prevalence and degrees of MMPVT in cirrhotic patients with HCC. Also, we aimed at determination of a correlation between the degree of MMPVT and both the tumour burden and the degree of liver function impairement. 1.3. Methods: The diagnosis of HCC in cirrhotic patients was based on the EASL guidelines. On contrast-enhanced CT scans, MMPVT was identified by the presence of a low-attenuation intra-luminal filling defect. Intrathrombus vascularity, observed in the arterial phase of imaging studies after the administration of contrast, has been reported to be a sign that is specific for MMPVT on CT [3]. MMPVT was graded into 4 grades according to Nonami grading [3]. Child-Turcotte-Puph (CTP) score was calculated for every patient and AFP was measured. Neutrophil- lymphocyte ratio (NLR) was calculated by dividing the neutrophil count by the lymphocyte count, provided that there was no ongoing infection. 1.4. Results: In 247 consecutive cirrhotic HCC patients (88.9% males, 11.1% females), the mean age was 58.87±7.42 years. MMPVT was detected in 63 patients (57 male, 6 females) representing 26% of all HCC cases. G1 MMPVT was present in 4 patients (6.3%), G2 in 19 patients (30.1%), G3 in 4 patients (6.3%) and G4 in 36 patients (57.1%). In HCC cases with MMPVT the tumor was multifocal or diffuse in 53 patients (82.5%) and unifocal in 11 patients (17.5%).The serum AFP level, CTP score and NLR were significantly higher in presence of MMPVT (P =.022,.005 and