Hepatic resection for hepatocellular carcinoma in patients with portal hypertension: a long-term benefit compared with transarterial chemoembolization and thermal ablation

Abstract

The optimal treatment for hepatocellular carcinoma (HCC) in cirrhotic patients with portal hypertension (PHT) is still controversial. The objective of this study is to compare HCC patients with PHT treated with hepatic resection to those treated with transarterial chemoembolization (TACE) or thermal ablation. A series of 167 cirrhotic patients with HCC undergoing hepatic resection or TACE/ablation from 2001 to 2008 were retrospectively analyzed. Cirrhotic patients with HCC were divided into 3 groups: hepatic resection in HCC patients with PHT (PHT-R group, n = 58), without PHT (NPHT-R group, n = 67), and TACE or thermal ablation in HCC patients with PHT (PHT-O group, n = 42). The short-term and long-term outcomes of liver function, operative mortality and morbidity, and survival rate were compared.Baseline characteristics were similar among the 3 groups, except for patients in the PHT-R group had larger spleen (16.0 vs 11.4 cm, P = 0.001) and smaller tumor size (4.8 vs 7.1 cm, P = 0.001) in comparison with those in the NPHT-R group. The PHT-R group had better liver function compared with those in the PHT-O group (patients had Child-Turcotte-Pugh class B liver function: 5.2% vs 31%, P = 0.001). There was no significant difference of operative mortality and morbidity in all groups. The 1-, 3-, 5-year survival rates were 80.4%, 55.6%, and 28.1% in the PHT-R group; 79.1%, 64.2%, and 39.8% in the NPHT-R group (vs PHT-R, P = 0.313); and 60.7%, 24.4%, and 7.3% in the PHT-O group (vs PHT-R, P < 0.001). Hepatic resection shows better long-term results for cirrhotic HCC patients with PHT than TACE and thermal ablation.

FIGURE 1

Overall survival curves of 167 cirrhotic patients undergoing liver resection for hepatocellular carcinoma with (PHT-R group) or without portal hypertension (NPHT-R group), and those with portal hypertension but performed other treatments (PHT-O group) (Kaplan–Meier method, long-rank test, P = 0.313 between PHT-R and NPHT-R groups; P < 0.001 between PHT-R and PHT-O groups; P < 0.001 between NPHT-R and PHT-O groups).

FIGURE 2

Tumor-free survivals of 125 cirrhotic patients undergoing liver resection for hepatocellular carcinoma with (PHT-R group) or without (NPHT-R group) portal hypertension (Kaplan–Meier method, long-rank test, P = 0.258).

FIGURE 3

Overall survival curves of 150 CTP class A cirrhotic patients undergoing liver resection for hepatocellular carcinoma with (PHT-R group) and without portal hypertension (NPHT-R group), and those with portal hypertension but performed other treatment (PHT-O group) (Kaplan–Meier method, long-rank test, P = 0.336 between PHT-R and NPHT-R groups; P = 0.002 between PHT-R and PHT-O groups; P < 0.001 between NPHT-R and PHT-O groups).