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. 2021 Oct;10(20):6985-6997.
doi: 10.1002/cam4.4222. Epub 2021 Aug 18.

Impact of portal hypertension on short- and long-term outcomes after liver resection for intrahepatic cholangiocarcinoma: A propensity score matching analysis

Jun Fu  1   2 , Qinjunjie Chen  3 , Yuyan Yu  4 , Wuyi You  4 , Zongren Ding  1   2 , Yuzhen Gao  5 , Haitao Li  1 , Yongyi Zeng  1
Affiliations

Impact of portal hypertension on short- and long-term outcomes after liver resection for intrahepatic cholangiocarcinoma: A propensity score matching analysis

Jun Fu et al. Cancer Med. 2021 Oct.

Abstract

Objective: We explored the impact of clinically significant portal hypertension (CSPH) on short- and long-term outcomes of intrahepatic cholangiocarcinoma (ICC) after liver resection (LR).

Methods: Data of 352 ICC patients with cirrhosis who underwent LR were extracted from the Primary Liver Cancer Big Data (PLCBD) between 2005 and 2015 and reviewed. A nomogram based on logistic analyses was developed to illustrate the influencing factors of post-hepatectomy liver failure (PHLF). The impact of CSPH on long-term survival was explored through propensity score matching (PSM) analysis, log-rank test, Cox proportional hazards model, and Kaplan-Meier curves.

Results: A total of 106 patients had CSPH, and 246 patients did not. A nomogram established based on GGT level, CSPH, intraoperative blood loss, and multiple tumors had an area under the receiver operating characteristic curve of 0.721 (95% confidence interval [CI] = 0.630-0.812), which displayed a better PHLF predictive value than the MELD score (0.639, 95% CI = 0.532-0.747) and Child-Pugh score (0.612, 95% CI = 0.506-0.719). Moreover, the patients with CSPH had worse overall survival (OS) rates than the patients without CSPH in the whole cohort (p = 0.011) and PSM cohort (p = 0.017). After PSM, multivariable Cox analyses identified that CSPH was an independent risk factor for OS (hazard ratio = 1.585, 95% CI = 1.107-2.269; p = 0.012).

Conclusion: CSPH is a significant risk factor for PHLF and OS in ICC patients with cirrhosis after surgery. Selecting the proper patients before operation can effectively avoid PHLF and improve the prognosis of ICC.

Keywords: hepatectomy; liver cancer; portal hypertension; prognosis; propensity score matching.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The flow chart of this study
FIGURE 2
FIGURE 2
(A) The nomogram integrating GGT, CSPH, intraoperative blood loss, and multiple tumors. (B) Calibration curves of the nomogram. (C) Comparison of PHLF prediction abilities among the nomogram, MELD score, and Child–Pugh score through the ROC analysis; the nomogram has the largest AUC value
FIGURE 3
FIGURE 3
Kaplan–Meier curves for ICC patients. (A) The OS of patients with or without CSPH before PSM. (B) The TTR of patients with or without CSPH before PSM. (C) The OS of patients with or without CSPH after PSM. (D) The TTR of patients with or without CSPH after PSM
See this image and copyright information in PMC

References

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