The impact of clinically significant portal hypertension on the prognosis of patients with hepatocellular carcinoma after radiofrequency ablation: a propensity score matching analysis.
OBJECTIVE
To assess the impact of clinically significant portal hypertension (CSPH) on the prognosis of patients with hepatocellular carcinoma (HCC) undergoing radiofrequency ablation (RFA).


METHODS
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/mm3associated 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.


RESULTS
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.


CONCLUSIONS
CSPH was not associated with poor outcomes after RFA.


CONCLUSIONS
• 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.
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Kuan-Chieh
KC
Fang
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Chien-Wei
CW
Su
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. yychiou@vghtpe.gov.tw.|Division of Gastrointestinal Radiology, Department of Radiology, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan. yychiou@vghtpe.gov.tw.
Yi-You
YY
Chiou
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Gastroenterology, Department of Internal Medicine, Yuanshan Branch, Taipei Veterans General Hospital, Yilan, Taiwan.|Department and Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Pei-Chang
PC
Lee
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Gastrointestinal Radiology, Department of Radiology, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan.
Nai-Chi
NC
Chiu
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Gastrointestinal Radiology, Department of Radiology, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan.
Chien-An
CA
Liu
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan.
Ping-Hsien
PH
Chen
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.|Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.|Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Wei-Yu
WY
Kao
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Yi-Hsiang
YH
Huang
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Department and Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Teh-Ia
TI
Huo
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan.
Ming-Chih
MC
Hou
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Han-Chieh
HC
Lin
Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
Jaw-Ching
JC
Wu
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010976:Platelet Count; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013163:Splenomegaly; D015996:Survival Rate; D016896:Treatment Outcome
Hepatocellular carcinoma; Oesophageal varices; Portal hypertension; Prognosis; Radiofrequency ablation
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