Back to Search Start Over

Prevalence and clinical significance of clinically evident portal hypertension in patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Authors :
Müller, Lukas
Hahn, Felix
Mähringer‐Kunz, Aline
Stoehr, Fabian
Gairing, Simon Johannes
Foerster, Friedrich
Weinmann, Arndt
Galle, Peter Robert
Mittler, Jens
Pinto dos Santos, Daniel
Pitton, Michael Bernhard
Düber, Christoph
Fehrenbach, Uli
Auer, Timo Alexander
Gebauer, Bernhard
Kloeckner, Roman
Source :
United European Gastroenterology Journal; February 2022, Vol. 10 Issue: 1 p41-53, 13p
Publication Year :
2022

Abstract

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

Details

Language :
English
ISSN :
20506406 and 20506414
Volume :
10
Issue :
1
Database :
Supplemental Index
Journal :
United European Gastroenterology Journal
Publication Type :
Periodical
Accession number :
ejs58886558
Full Text :
https://doi.org/10.1002/ueg2.12188