Prevalence and Clinical Significance of Clinically Evident Portal Hypertension in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

Overview

Journal United European Gastroenterol J

Publisher Wiley

Specialty Gastroenterology

Date 2021 Dec 17

PMID 34918471

Citations 9

Authors

Lukas Muller

Felix Hahn

Aline Mahringer-Kunz

Fabian Stoehr

Simon Johannes Gairing

Friedrich Foerster

Arndt Weinmann

Peter Robert Galle

Jens Mittler

Daniel Pinto Dos Santos

Michael Bernhard Pitton

Christoph Duber

Uli Fehrenbach

Timo Alexander Auer

Bernhard Gebauer

Roman Kloeckner

Affiliations

Soon will be listed here.

Abstract

Background: Clinically evident portal hypertension (CEPH) was previously identified as a prognostic factor for patients with hepatocellular carcinoma (HCC). However, little is known about the prognostic influence of CEPH on the long-term outcome of patients with HCC undergoing transarterial chemoembolization (TACE), particularly in Western populations.

Objectives: This study investigated the prevalence and prognostic influence of CEPH in a Western population of patients with HCC undergoing TACE.

Methods: This retrospective study included 349 treatment-naïve patients that received initial TACE treatment at our tertiary care center between January 2010 and November 2020. CEPH was defined as a combination of ascites, esophageal/gastric varices, splenomegaly and a low platelet count. We assessed the influence of CEPH and its defining factors on median overall survival (OS) in HCC patients. We compared the effects of CEPH to those of well-known prognostic factors.

Results: Of the 349 patients included, 304 (87.1%) patients had liver cirrhosis. CEPH was present in 241 (69.1%) patients. The median OS times were 10.6 months for patients with CEPH and 17.1 months for patients without CEPH (log rank p = 0.036). Median OS without a present surrogate was 17.1 months, while patients with one respectively more than two present CEPH surrogates had a median OS of 10.8 and 9.4 months (log rank p = 0.053). In multivariate analysis, CEPH was no significant risk factor for OS (p = 0.190). Of the CEPH-defining factors, only ascites reached significance in a univariate analysis.

Conclusion: CEPH was present in more than two thirds of the patients with HCC undergoing TACE in our cohort of Western patients. Patients with CEPH had a significantly impaired survival in univariate analysis. However, no significance was reached in multivariate analysis. Thus, when TACE treatment is deemed oncologically reasonable, patients should not be excluded from TACE treatment due to the presence of surrogates of portal hypertension alone.

Citing Articles

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Partial hepatectomy versus interventional treatment in patients with hepatitis B virus-related hepatocellular carcinoma and clinically significant portal hypertension: a randomized comparative clinical trial.

Yuan Y, Peng H, He W, Zheng Y, Qiu J, Chen B Cancer Commun (Lond). 2024; 44(11):1337-1349.

PMID: 39322951 PMC: 11570767. DOI: 10.1002/cac2.12614.

Amount of ascites impacts survival in patients with hepatocellular carcinoma undergoing transarterial chemoembolization advocating for volumetric assessment.

Muller L, Bender D, Gairing S, Foerster F, Weinmann A, Mittler J Sci Rep. 2024; 14(1):16550.

PMID: 39019953 PMC: 11255265. DOI: 10.1038/s41598-024-67312-2.

Portal-hypertension features are associated with ascites occurrence and survival in patients with hepatocellular carcinoma treated by external radiotherapy.

Giudicelli H, Andraud M, Wagner M, Bourdais R, Goumard C, Scatton O United European Gastroenterol J. 2023; 11(10):985-997.

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Muller L, Gairing S, Foerster F, Weinmann A, Mittler J, Stoehr F Cancer Imaging. 2023; 23(1):40.

PMID: 37098584 PMC: 10127076. DOI: 10.1186/s40644-023-00558-7.

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