Early risk warning system for distant metastasis of hepatitis B virus-associated hepatocellular carcinoma with portal vein tumor thrombus.

Portal vein tumor thrombus (PVTT) promotes distant metastasis of hepatocellular carcinoma (HCC), which increases the mortality of patients with HCC and PVTT. The aim of the present study was to develop an early risk warning system for distant metastasis of hepatitis B virus (HBV)-associated primary HCC (HBV-HCC) with PVTT. Data from 346 patients (263 and 83 in the modeling and validation cohorts, respectively) who had received primary diagnoses of HBV-HCC and PVTT between January 2012 and June 2015 at Beijing Ditan Hospital (Beijing, China) were retrospectively examined. In the modeling cohort, univariate and multivariate logistic regression analyses were conducted to determine the factors that were significantly associated with distant metastasis. Furthermore, an early risk warning model for distant metastasis was proposed and validated through receiver operating characteristic curve analysis in the validation cohort. The results revealed that neutrophil to lymphocyte ratios of ≥2.31, red blood cell counts of ≥4.07×1012 cells/l, C-reactive protein levels of ≥7.02 mg/l, aspartate aminotransferase levels of ≥118.5 U/l and tumor thrombus site (at branch) were significantly positively associated with distant metastasis of HBV-HCC with PVTT (P<0.05; odds ratio >1.000). A formula for predicting distant metastasis was obtained with an accuracy of ~70%. The results of the present study may allow for the early prediction of distant metastasis and facilitate the administration of appropriate treatment to improve the outcomes and prognosis of patients with intermediate to advanced HCC.