The impact of clinically significant portal hypertension on the prognosis of patients with hepatocellular carcinoma after radiofrequency ablation: a propensity score matching analysis
To assess the impact of clinically significant portal hypertension (CSPH) on the prognosis of patients with hepatocellular carcinoma (HCC) undergoing radiofrequency ablation (RFA).
We retrospectively enrolled 280 treatment-naïve early-stage HCC patients who had Child–Pugh grade A or B and received upper gastrointestinal endoscopy at the time of HCC diagnosis. CSPH was defined as (1) a platelet count < 100,000/mm3 associated with splenomegaly and/or (2) the presence of oesophageal/gastric varices by endoscopy. Factors determining poor overall survival and recurrence after RFA were analysed by Cox proportional hazards model and propensity score matching analysis.
A total of 192 (68.6 %) patients had CSPH. The cumulative 5-year survival rates were 50.6 % and 76.7 % in patients with and without CSPH, respectively (p = 0.015). Based on multivariate analysis, age > 65 years (hazard ratio (HR) 1.740, p = 0.025), serum albumin levels ≤ 3.5 g/dL (HR 3.268, p < 0.001) and multiple tumours (HR 1.693, p = 0.046), but not CSPH, were independent risk factors associated with poor overall survival after RFA. Moreover, the overall survival rates were comparable between patients with and without CSPH after adjusting for confounding factors via propensity score matching analysis.
CSPH was not associated with poor outcomes after RFA.
• CSPH was common in HCC patients who underwent RFA therapy.
• CSPH was not an independent risk factor in determining poor prognosis.
• Serum albumin level was more important to determine the outcomes.
KeywordsOesophageal varices Hepatocellular carcinoma Portal hypertension Prognosis Radiofrequency ablation
American Association for the Study of Liver Disease
Barcelona Clinic Liver Cancer
clinically significant portal hypertension
European Association for the Study of the Liver
hepatitis B surface antigen
hepatitis B virus
hepatitis C virus
hepatic venous pressure gradient
Institutional review board
magnetic resonance imaging
prothrombin time/international ratio
radiofrequency ablation therapy
The authors thank American Manuscript Editors for English editing and writing assistance. This work was supported by grants from the National Science Council of Taiwan (NSC 101-2314-B-075-013-MY2), Ministry of Science and Technology of Taiwan (MOST 103-2314-B-075-077, and 104-2314-B-075-076), grants from Taipei Veterans General Hospital (V102C-117 and V104-111), a grant from the Ministry of Education Aim for the Top University Plan (103 AC-T402) and a grant from the Center of Excellence for Cancer Research at TVGH (MOHW104-TDU-B-211-124-001) in Taipei, Taiwan. We also thank for the Clinical Research Core Laboratory of Taipei Veterans General Hospital for providing experimental space and facilities. We thank Pui-Ching Lee for kindly providing statistical advice for this manuscript. Yi-You Chiou is the guarantor for the entire study. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in an oral presentation at the 23rd United European Gastroenterology Week in 2015. Methodology: retrospective, observational, performed at one institution.
- 3.Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC (2005) Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut 54:1151–1156CrossRefPubMedPubMedCentralGoogle Scholar