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Clinically significant portal hypertension (CSPH) on early-stage HCC following hepatectomy: What's the impact?

  • Feng Xia
    Affiliations
    Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
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  • Zhiyuan Huang
    Affiliations
    Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
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  • Qiao Zhang
    Affiliations
    Zhongshan People's Hospital Affiliated to Guangdong Medical University, Guangdong, China
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  • Elijah Ndhlovu
    Affiliations
    Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
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  • Xiaoping Chen
    Affiliations
    Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
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  • Bixiang Zhang
    Affiliations
    Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
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  • Peng Zhu
    Correspondence
    Corresponding author. Hepatic Surgery Center, Institute of HBP Surgery, Tongji, Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, China.
    Affiliations
    Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
    Search for articles by this author
Published:November 07, 2022DOI:https://doi.org/10.1016/j.ejso.2022.11.005

      Abstract

      Background and aim

      The impact of currently clinically significant portal hypertension (CSPH) for patients with early-stage HCC after surgery remains controversial. The purpose of this study is to understand the specific effect of CSPH on patients with early-stage (BCLC A stage) HCC after surgery.

      Methods

      We collected data from 386 HCC patients treated at two centers from December 2009 to January 2017.224 patients (all treated by hepatectomy) were in BCLC stage A, of which, 122 had no CSPH, and 102 had CSPH. There were 162 patients in BCLC stage B (who underwent surgery, TACE, and conservative treatment). The prognosis of the CSPH and non-CSPH groups in BCLC stage A was compared using the Kaplan-Meier method. We used multivariate Cox regression to analyze prognostic factors in patients in BCLC stage A and compared the prognosis of the two groups with the BCLC stage B group.

      Results

      Among the 224 BCLC stage A patients after surgery, the overall survival (OS) and recurrence-free survival (RFS) of the CSPH group were worse than those of the non-CSPH group (P < 0.001, HR = 2.340[1.554–3.523]; P < 0.001, HR = 2.577[1.676–3.812]) The multivariate Cox proportional hazards model indicated that CSPH was an independent prognostic factor for OS and RFS in BCLC stage A patients. BCLC stage A patients with CSPH treated by hepatectomy had a comparable prognosis to BCLC B stage patients (P = 0.378), and the OS and RFS (P = 0.229; P = 0.077) in the CSPH (BCLC A) group were also comparable to BCLC stage B patients treated with surgery alone.

      Conclusions

      CSPH can affect the surgical prognosis of early-stage (BCLC stage A) HCC. BCLC stage A patients with CSPH have a prognosis comparable to patients with BCLC stage B. An additional stage, such as the BCLC stage A-B, can be considered.

      Keywords

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