Pre-treatment hemodynamic features involved with long-term survival of cirrhotic patients after embolization of gastric fundal varices.
OBJECTIVE
To clarify the pre-treatment hemodynamic features involved in the long-term survival of cirrhotic patients with gastric fundal varices (FV) after balloon-occluded retrograde transvenous obliteration (B-RTO).


METHODS
Eighty-one cirrhotic patients with medium- or large-grade FV treated by B-RTO were enrolled in this retrospective study. Pre-treatment flow volume ratio between gastric vein and portal trunk (GP-R) was obtained by Doppler ultrasound.


RESULTS
The cumulative survival rate was 90% at 1 year, 74.8% at 3 years, 57.2% at 5 years, and 45.8% at 7 years without recurrence in a median period of 1148.5 days The survival was poorer in patients with HCC (47% at 3 years, 9.4% at 5 years, p<0.0001) than without (89.2% at 3 years, 81.9% at 5 years, 67.5% at 7 years), in patients with Child B/C (57.7% at 3 years, 42.1% at 5 years, 28.1% at 7 years, p=0.0016) than with Child A (91.8% at 3 years, 71.5% at 5 years, 62.1% at 7 years), and in patients with GP-R > or = 1.0 (58.9% at 3 years, p=0.0485) than with GP-R<1.0 (76.3% at 3 years, 62% at 5 years, 49.6% at 7 years). Multivariate analysis identified the presence of HCC (hazard ratio, 12.486; 95% CI, 4.08-38.216; p<0.0001), Child B/C (hazard ratio, 3.41; 95% CI, 1.594-7.15; p=0.0051) and GP-R > or = 1.0 (hazard ratio, 2.701; 95% CI, 1.07-6.15; p=0.0221) as independent factors for poor prognosis.


CONCLUSIONS
GP-R > r= 1.0 on Doppler ultrasound before B-RTO may be a predictive indicator for poor prognosis in cirrhotic patients with FV after B-RTO, in addition to the presence of HCC and severe liver damage.
Maruyama
Hitoshi
H
Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan. maru-cib@umin.ac.jp
Okugawa
Hidehiro
H
Kobayashi
Satoshi
S
Yoshizumi
Hiroaki
H
Yokosuka
Osamu
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion; D001783:Blood Flow Velocity; D006528:Carcinoma, Hepatocellular / Q000150:complications; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006439:Hemodynamics; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000503:physiopathology*; D011379:Prognosis; D013270:Stomach / Q000098:blood supply*; D015996:Survival Rate; D018608:Ultrasonography, Doppler; D014680:Veins