title: Resection versus ablation in hepatitis B virus-related hepatocellular carcinoma patients with portal hypertension: A propensity score matching study.
abstract: BACKGROUND
  With recent improvements in operative techniques, many studies have reported that resection is safe for hepatocellular carcinoma (HCC) patients with portal hypertension (PHT). However, no direct evidence exists to compare resection with ablation in patients with hepatitis B virus (HBV)-related PHT.
  
  
  METHODS
  Of 259 HBV-related PHT patients who met the Milan criteria, 123 patients underwent resection and 136 underwent ablation as a primary treatment. Complications were graded with the Clavien-Dindo system, and oncologic outcomes were analyzed with a propensity score matching (PSM) method.
  
  
  RESULTS
  Compared with the ablation group, the resection group showed larger tumors, greater white blood cell counts, greater platelet counts, lower γ-glutamyltransferase levels, and lower model of end stage liver disease scores (all P < .05). Although more frequent complications occurred in the resection group (P < .001), the difference was significant for the Grade I complications but not for Grade II-V complications. The recurrence-free survival (RFS) and overall survival (OS) rates were greater in the resection group than in the ablation group (P = .001 and P = .010, respectively). After one-to-one PSM, 77 resection patients and 77 ablation patients were selected for further analyses. The advantages of resection over ablation were still observed in RFS (P = .002) and OS (P = .012). Grade I-V complications were comparable between the 2 groups (all P > .100).
  
  
  CONCLUSIONS
  Resection is safe and confers a survival advantage over ablation in HBV-related PHT patients. Resection may be recommended as an optimal treatment for these patients.
authors.affiliation: State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
authors.forename: Jiliang
authors.initials: J
authors.lastname: Qiu
authors.affiliation: State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Medical Imaging and Interventional Center, Sun Yat-Sen University Cancer Center, Guangzhou, China.
authors.forename: Jingxian
authors.initials: J
authors.lastname: Shen
authors.affiliation: Department of General Surgery, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China.
authors.forename: Qing-An
authors.initials: QA
authors.lastname: Zeng
authors.affiliation: State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
authors.forename: Ruhai
authors.initials: R
authors.lastname: Zou
authors.affiliation: State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
authors.forename: Yadi
authors.initials: Y
authors.lastname: Liao
authors.affiliation: State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
authors.forename: Wei
authors.initials: W
authors.lastname: He
authors.affiliation: State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
authors.forename: Qijiong
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Guihua
authors.initials: G
authors.lastname: Chen
authors.affiliation: State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China. Electronic address: libinkui@mail.sysu.edu.cn.
authors.forename: Binkui
authors.initials: B
authors.lastname: Li
authors.affiliation: State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China. Electronic address: yuanyf@mail.sysu.edu.cn.
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Yuan
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery* / Q000821:virology; D017115:Catheter Ablation; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006509:Hepatitis B / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D015996:Survival Rate; D016896:Treatment Outcome