title: What are the risk factors for aggravation of esophageal varices in patients with hepatocellular carcinoma?
abstract: OBJECTIVE
  The risk factors for aggravation of esophageal varices (EV) in patients with hepatocellular carcinoma (HCC) are poorly understood. The aim of this study was to evaluate the effects of HCC on the appearance of the red color (RC) sign on EV and also investigate whether risk factors for the appearance of the RC sign differed between patients with and without HCC.
  
  
  METHODS
  A total of 243 patients with cirrhosis (127 with HCC, 116 without HCC) without the RC sign, with no previous variceal hemorrhage, and not on prophylactic treatment for EV were enrolled. The endpoint was defined as being either when the RC sign was first noted, or when variceal bleeding occurred. In patients without HCC, follow-up was discontinued if HCC was discovered. The risk factors were analyzed by Cox proportional hazards regression.
  
  
  RESULTS
  In patients with HCC, portal vein tumor thrombus was a statistically independent risk factor (risk ratio [RR] 4.58, 95% confidence interval [CI] 1.32-15.86), although the presence of HCC was not. A large HCC (> or =50 mm) tended to be a risk factor, but this was not statistically significant (RR 2.50, 95%CI 0.98-6.39). Child-Pugh classification and low platelet count were common risk factors regardless of whether HCC was present or not.
  
  
  CONCLUSIONS
  Portal vein tumor thrombus, but not the presence of HCC, was a significant risk factor for aggravation of EV in patients with HCC. Cirrhotic patients with portal vein tumor thrombus should receive more aggressive management of portal hypertension to prevent aggravation of EV.
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Kadouchi
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Higuchi
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Shiba
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Okazaki
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yamamori
authors.forename: Eiji
authors.initials: E
authors.lastname: Sasaki
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tominaga
authors.forename: Toshio
authors.initials: T
authors.lastname: Watanabe
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Oshitani
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Arakawa
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications*; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index