ArticleBMC cancer2021
Variceal bleeding is aggravated by portal venous invasion of hepatocellular carcinoma: a matched nested case-control study.
Article in BMC cancer, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06594744 (A Randomized Controlled Trial of Endoscopic Variceal Ligation Versus Carvedilol for the Prevention of First Esophageal Variceal Bleeding in Patients With Hepatocellular Carcinoma), which is not on this map. Cited by 32 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Randomized Controlled Trial of Endoscopic Variceal Ligation Versus Carvedilol for the Prevention of First Esophageal Variceal Bleeding in Patients With Hepatocellular Carcinoma
Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it, 51 citations in OpenAlex.
- Meta-analysis: accuracy of the Baveno VI criteria for the diagnosis of high-risk varices in patients with hepatocellular carcinoma.Frontiers in oncology · 2024Pooled it
- Transjugular intrahepatic portosystemic shunt in patients with hepatocellular carcinoma: A systematic review.United European gastroenterology journal · 2023Pooled it
- Patient characteristics to guide personalized treatment decisions and prognostication in hepatocellular carcinoma.Hepatic oncology · 2026Review
- Gastrointestinal bleeding in hepatocellular carcinoma under systemic therapy: Real-world incidence and clinical predictors.Clinics (Sao Paulo, Brazil) · 2026Article
- Using the EVendo Score to Predict Varices and Varices Needing Treatment in Hepatocellular Carcinoma Patients Planned for Atezolizumab-Bevacizumab.Digestive diseases and sciences · 2026Article
- Acute Upper Gastrointestinal Bleeding is Associated With Poor Prognosis in Patients With Biliary Tract Cancer.Cancer medicine · 2026Observational
- Esophagogastric Variceal Bleeding in Cirrhotic Patients with Hepatocellular Carcinoma Receiving Systemic Therapy: A Retrospective Cohort Study.Journal of hepatocellular carcinoma · 2026Article
- Case Report: Percutaneous portal-central venous bypass: a novel salvage therapy for refractory variceal bleeding in TIPS-ineligible patients with portal vein tumor thrombus.Frontiers in medicine · 2026Article
- Development and validation of a score model for predicting the risk of first esophagogastric variceal hemorrhage and mortality in patients with hepatocellular carcinoma.Annals of medicine · 2025Article
- Comparative efficacy and safety of lenvatinib, sintilimab combined interventional therapy vs bevacizumab, sintilimab combined interventional therapy in intermediate and advanced hepatocellular carcinoma: a multicenter retrospective study.World journal of surgical oncology · 2025Article
- Risk prediction of acute variceal bleeding in hepatocellular carcinoma patients undergoing systemic therapy based on immune checkpoint inhibitors.World journal of gastrointestinal oncology · 2025Article
- Features on contrast-enhanced computed tomography for predicting recurrent esophageal variceal bleeding in patients with hepatocellular carcinoma.BMC gastroenterology · 2025Article
- HAIC plus lenvatinib and tislelizumab for advanced hepatocellular carcinoma with Vp4 portal vein invasion.Hepatology international · 2025Article
- Primary Prophylaxis for High-Risk Varices in Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombus Delayed Hepatic Decompensation: A Retrospective, Propensity Score Matching Study.Journal of hepatocellular carcinoma · 2025Article
- Article
- Efficacy and Safety of Atezolizumab plus Bevacizumab versus Sorafenib in Hepatocellular Carcinoma with Main Trunk and/or Contralateral Portal Vein Invasion in IMbrave150.Liver cancer · 2024Article
- Transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding in patients with hepatocellular carcinoma and portal vein tumor thrombus.World journal of gastrointestinal surgery · 2024Article
- Article
- HCC portal hypertension imaging score derived from CT predicts re-bleeding and mortality after acute variceal bleeding.Cancer imaging : the official publication of the International Cancer Imaging Society · 2024Article
- Management of varices but not anticoagulation is associated with improved outcome in patients with HCC and macrovascular tumour invasion.Cancer imaging : the official publication of the International Cancer Imaging Society · 2024Article
Corrections and comments
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Authors and funding
10 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundWe hypothesized that portal vein tumor thrombosis (PVTT) in hepatocellular carcinoma (HCC) increases portal pressure and causes esophageal varices and variceal bleedings. We examined the incidence of high-risk varices and variceal bleeding and determined the indications for variceal screening and prophylaxis.
methodsThis study included 1709 asymptomatic patients without any prior history of variceal hemorrhage or endoscopic prophylaxis who underwent upper endoscopy within 30 days before or after initial anti-HCC treatment. Of these patients, 206 had PVTT, and after 1:2 individual matching, 161 of them were matched with 309 patients without PVTT. High-risk varices were defined as large/medium varices or small varices with red-color signs and variceal bleeding. Bleeding rates from the varices were compared between matched pairs. Risk factors for variceal bleeding in the entire set of patients with PVTT were also explored.
resultsIn the matched-pair analysis, the proportion of high-risk varices at screening (23.0% vs. 13.3%; P = 0.003) and the cumulative rate of variceal bleeding (4.5% vs. 0.4% at 1 year; P = 0.009) were significantly greater in the PVTT group. Prolonged prothrombin time, lower platelet count, presence of extrahepatic metastasis, and Vp4 PVTT were independent risk factors related to high-risk varices in the total set of 206 patients with PVTT (Adjusted odds ratios [95% CIs], 1.662 [1.151-2.401]; 0.985 [0.978-0.993]; 4.240 [1.783-10.084]; and 3.345 [1.457-7.680], respectively; Ps < 0.05). During a median follow-up of 43.2 months, 10 patients with PVTT experienced variceal bleeding episodes, 9 of whom (90%) had high-risk varices. Presence of high-risk varices and sorafenib use for HCC treatment were significant predictors of variceal bleeding in the complete set of patients with PVTT (Adjusted hazard ratios [95% CIs], 26.432 [3.230-216.289]; and 5.676 [1.273-25.300], respectively; Ps < 0.05).
conclusionsPVTT in HCC appears to increase the likelihood of high-risk varices and variceal bleeding. In HCC patients with PVTT, endoscopic prevention could be considered, at least in high-risk variceal carriers taking sorafenib.
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