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The impact of clinically significant portal hypertension on the prognosis of patients with hepatocellular carcinoma after radiofrequency ablation: a propensity score matching analysis

  • Hepatobiliary-Pancreas
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Abstract

Objectives

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/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.

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.

Key points

• 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.

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Abbreviations

AASLD:

American Association for the Study of Liver Disease

AFP:

alpha-fetoprotein

Alk-P:

alkaline phosphatase

ALT:

alanine aminotransferase

AST:

aspartate aminotransferase

BCLC:

Barcelona Clinic Liver Cancer

CI:

confidence interval

CSPH:

clinically significant portal hypertension

CT:

computed tomography

EASL:

European Association for the Study of the Liver

EGV:

oesophageal-gastric varix

EV:

oesophageal varix

GV:

gastric varix

HBsAg:

hepatitis B surface antigen

HBV:

hepatitis B virus

HCC:

hepatocellular carcinoma

HCV:

hepatitis C virus

HR:

hazard ratio

HVPG:

hepatic venous pressure gradient

IRB:

Institutional review board

MRI:

magnetic resonance imaging

OS:

overall survival

PH:

portal hypertension

PT/INR:

prothrombin time/international ratio

RFA:

radiofrequency ablation therapy

RFS:

recurrence-free survival

TACE:

transarterial chemoembolization

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Acknowledgments

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.

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Author notes

    Authors and Affiliations

    1. Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

      Kuan-Chieh Fang, Chien-Wei Su, Yi-Hsiang Huang, Teh-Ia Huo, Ming-Chih Hou & Han-Chieh Lin

    2. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

      Chien-Wei Su, Yi-You Chiou, Pei-Chang Lee, Nai-Chi Chiu, Chien-An Liu, Ping-Hsien Chen, Wei-Yu Kao, Ming-Chih Hou & Han-Chieh Lin

    3. Division of Gastrointestinal Radiology, Department of Radiology, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan

      Yi-You Chiou, Nai-Chi Chiu & Chien-An Liu

    4. Division of Gastroenterology, Department of Internal Medicine, Yuanshan Branch, Taipei Veterans General Hospital, Yilan, Taiwan

      Pei-Chang Lee

    5. Department and Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan

      Pei-Chang Lee & Teh-Ia Huo

    6. Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan

      Ping-Hsien Chen & Ming-Chih Hou

    7. Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan

      Ping-Hsien Chen

    8. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan

      Wei-Yu Kao

    9. Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

      Wei-Yu Kao

    10. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

      Wei-Yu Kao

    11. Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

      Yi-Hsiang Huang & Jaw-Ching Wu

    12. Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan

      Jaw-Ching Wu

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    1. Kuan-Chieh Fang
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    Correspondence to Yi-You Chiou.

    Additional information

    Kuan-Chieh Fang and Chien-Wei Su contributed equally to this work.

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    Fig. S1

    Cumulative curves of OS rates in HCC patients after RFA stratified by CSPH status and serum albumin levels. Patients with serum albumin levels > 3.5 g/dL had a higher OS rate than their counterparts among both patients with CSPH (S1A, p = 0.003) and patients without CSPH (S1B, p = 0.006). (GIF 49 kb)

    (GIF 47 kb)

    High resolution image (TIF 51 kb)

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    Fig. S2

    Cumulative curves of OS rates after RFA in patients with BCCL stage 0 HCC stratified by CSPH status and serum albumin levels. Patients with serum albumin levels > 3.5 g/dL had a higher OS rate than their counterparts among all patients (S1A, p < 0.001), among patients with CSPH (S1B, p < 0.001) and among patients without CSPH (S1C, p = 0.010). (GIF 46 kb)

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    High resolution image (TIF 48 kb)

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    (TIF 49 kb)

    Fig. S3

    Cumulative RFS curves after RFA for patients with HCC stratified by CSPH. A. The cumulative RFS rates were similar between patients with and without CSPH both before (S3A, p = 0.575) and after propensity score matching analysis (S3B, p = 0.856). In addition, for patients with BCLC stage 0 HCC, the RFS rates were also comparable between the two groups of patients (S3C, p = 0.719). (GIF 352 kb)

    (GIF 66 kb)

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    High resolution image (TIF 175 kb)

    (TIF 103 kb)

    (TIF 102 kb)

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    Fang, KC., Su, CW., Chiou, YY. et al. The impact of clinically significant portal hypertension on the prognosis of patients with hepatocellular carcinoma after radiofrequency ablation: a propensity score matching analysis. Eur Radiol 27, 2600–2609 (2017). https://doi.org/10.1007/s00330-016-4604-z

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