Kuan-Chieh Fang1, Chien-Wei Su1,2, Yi-You Chiou3,4, Pei-Chang Lee2,5,6, Nai-Chi Chiu2,7, Chien-An Liu2,7, Ping-Hsien Chen2,8,9, Wei-Yu Kao2,10,11,12, Yi-Hsiang Huang1,13, Teh-Ia Huo1,6, Ming-Chih Hou1,2,8, Han-Chieh Lin1,2, Jaw-Ching Wu13,14. 1. Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 2. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 3. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. yychiou@vghtpe.gov.tw. 4. Division of Gastrointestinal Radiology, Department of Radiology, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan. yychiou@vghtpe.gov.tw. 5. Division of Gastroenterology, Department of Internal Medicine, Yuanshan Branch, Taipei Veterans General Hospital, Yilan, Taiwan. 6. Department and Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 7. Division of Gastrointestinal Radiology, Department of Radiology, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan. 8. Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan. 9. Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan. 10. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan. 11. Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 12. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 13. Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 14. Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
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.
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.
Authors: Patrick Marcellin; Edward Gane; Maria Buti; Nezam Afdhal; William Sievert; Ira M Jacobson; Mary Kay Washington; George Germanidis; John F Flaherty; Raul Aguilar Schall; Jeffrey D Bornstein; Kathryn M Kitrinos; G Mani Subramanian; John G McHutchison; E Jenny Heathcote Journal: Lancet Date: 2012-12-10 Impact factor: 79.321
Authors: L Bucci; F Garuti; V Camelli; B Lenzi; F Farinati; E G Giannini; F Ciccarese; F Piscaglia; G L Rapaccini; M Di Marco; E Caturelli; M Zoli; F Borzio; R Sacco; M Maida; M Felder; F Morisco; A Gasbarrini; S Gemini; F G Foschi; G Missale; A Masotto; A Affronti; M Bernardi; F Trevisani Journal: Aliment Pharmacol Ther Date: 2015-12-14 Impact factor: 8.171