Hepatocellular carcinoma in cirrhotic patients with portal hypertension: Is liver resection always contraindicated?

Table 1 Patients characteristics according to the presence/absence of portal hypertension

Variable	Portal hypertension		Pvalue
	Yes (%)	No (%)
n	44	91
Age (yr)			0.55
< 70	31 (70)	60 (66)
> 70	13 (30)	31 (34)
Etiology of liver disease			0.21
Alcohol	7 (16)	24 (26)
Viral hepatitis	36 (82)	59 (65)
Other	1 (2)	8 (9)
Serum ALT level (U/L)			0.01
< 80	23 (52)	74 (81)
> 80	21 (48)	17 (19)
Serum AST level (U/L)			0.01
< 80	21 (48)	68 (75)
> 80	23 (52)	23 (25)
Child-Pugh class			0.01
Class A	29 (66)	81 (89)
Class B	15 (33)	10 (11)
Bilirubin level (mg/dL)			0.01
< 2	31 (71)	88 (97)
2-3	8 (18)	3 (3)
> 3	5 (11)	0 (0)
Albumin level (g/L)			0.01
< 28	7 (16)	8 (9)
28-35	18 (41)	14 (15)
> 35	19 (43)	69 (76)
Platelet count			0.01
≤ 100 000/mm3	31 (70)	0
> 100 000/mm3	13 (30)	91 (100)
Esophageal varices			0.01
Yes	17 (39)	0
No	27 (61)	91 (100)
α-fetoprotein level (ng/dL)			0.86
< 20	19 (43)	42 (46)
> 20	25 (57)	49 (54)
Size (cm)			0.03
< 3	14 (32)	30 (33)
3-5	21 (48)	23 (25
> 5	9 (20)	38 (42)
Number of nodules			0.51
Single	32 (73)	65 (72)
2 HCC	8 (18)	12 (13)
3 HCC or more	4 (9)	14 (15)
Macrovascular Invasion			0.16
No	42 (95)	73 (80)
Yes	2 (5)	18 (20)
Microvascular invasion			0.24
No	29 (66)	43 (47)
Yes	15 (34)	48 (53)
Type of hepatectomy			0.58
Wedge resection	10 (23)	16 (18)
Segmentectomy	26 (59)	52 (57)
More than 1 segment	8 (18)	23 (25)

ALT: Alanine transaminase; AST: Aspartate transaminase; HCC: Hepatocellular carcinoma.

Table 2 Mortality and morbidity rates according to the presence/absence of portal hypertension

	Portal hypertension		P value
	Yes (%)	No (%)
n	44	91
1 mo mortality	2 (4.6)	1 (1.1)	0.20
3 mo mortality	6 (13.6)	3 (3.3)	0.05
Overall morbidity	16 (37)	29 (32)	0.59
Cardiac complications	0	3 (3.3)	0.20
Pulmonary complications	10 (23)	18 (20)	0.71
Hepatic complications	14 (32)	12 (13)	0.03

Table 3 Survival analysis according to different groups of patient and presence/absence of portal hypertension

Variable	n	Median survival (mo, 95% CI)	Survival		P value
			3-yr	5-yr
Overall					0.047
Without PH	91	65.1 (49.7-80.4)	68.4	61.2
With PH	44	31.6 (3.4-59.9)	48.7	44.9
Child-Pugh B					0.465
Without PH	10	27.7 (1.3-65.5)	31.3	31.3
With PH	15	15.1 (11.7-18.5)	11.9	-
Child-Pugh A					0.257
Without PH	81	65.1 (47.7-82.4)	72.0	63.2
With PH	29	60.5 (6.4-114.6)	63.0	57.3
CP A-limited Hx					0.458
Without PH	58	64.9 (62.9-67.0)	72.4	61.4
With PH	21	94.0 (54.0-134.0)	72.7	72.7
CP A-Hx ≥ 2 segments					0.035
Without PH	23	163.9 (-)	64.5	64.5
With PH	8	64.4 (54.0-134.0)	50.0	25.0

CI: Confidence interval; PH: Portal hypertension; CP: Child-Pugh score; Hx: Hepatic resection.

Table 4 Multivariate Cox’s regression model of variables related to survival

Variable	HR	95% CI	P value
Child-Pugh class (B vs A)	2.57	1.31-5.01	0.005
Type of hepatectomy (≥ 2 segments vs limited)	1.05	0.50-2.21	0.880
PH (presence vs absence)	1.51	0.84-2.68	0.160

CI: Confidence interval; PH: Portal hypertension.