Portal vein thrombosis in hepatocellular carcinoma. How can we predict it

Background: Portal vein thrombosis (PVT) is frequently associated with liver cancer. The aim of this study was to find predictive factors of PVT presence at the time of hepatocellular carcinoma (HCC) diagnosis developed in liver cirrhosis, by ultrasound examination. Methods: A 3 year cohort study was carried out, including all cases referred to our centre with HCC developed on liver cirrhosis. Two groups were comparatively analyzed, with and without PVT. The differences between these groups were comparatively assessed. Results: PVT was present at 39 of 97 patients (40.2%). The HCC lesions were: diffuse (39.20%), uninodular (53.60%) and multiple (7.20%). Liver segment 7 was affected in 50% of cases. The median diameter of the lesion was 53.80mm. PVT was associated with non alcoholic aetiology (p=0.013), ascites (p=0.011), macro nodular structure of liver parenchyma (p=0.011) and absence of peripheral hallo (p=0.008). Gallbladder wall thickness and serum alfafetoprotein (AFP) were also discriminative for PVT (p=0.030 and p=0.024 respectively, Mann-Whitney test). On the receiver operating characteristics curves gallbladder wall thickness and AFP specificities were 96% and 81% for cut off-values of 8mm and 400ng/ml. In multivariate analysis the independent factors of PVT were macro nodular structure (p=0.014, odds ratio (OR)=3.7, 95% confidence limits (95%CI) 1.3–10.4), absence of peripheral hallo (p=0.006, OR = 0.2, 95%CI 0.05 – 0.8) and gallbladder wall thickness over 8mm (p=0.032, OR=4.1, 95%CI 1.5 -1.7). Conclusions: A lesion without peripheral hallo in a macro nodular liver structure and a thick gallbladder wall on ultrasound examination may predict associated portal vein thrombosis when hepatocellular carcinoma is diagnosed.