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Background <p>Portal hypertension restricts the available therapeutic choices for hepatocellular carcinoma (HCC), adversely impacting patients’ prognosis. Established guidelines regarding the treatment of patients with clinically significant portal hypertension (CSPH) are still a matter of debate. This study aimed to evaluate the therapeutic outcomes and identify the optimal treatment strategy for such a population.</p> Materials and Methods <p>The Kaplan–Meier&#xa0;method was utilized for survival analyses. The inverse probability of treatment weighting&#xa0;and multivariate&#xa0;Cox regression models were implemented to adjust for confounding covariates. The relationships between prognostic index and observation end points were evaluated using restricted cubic spline curves.</p> Results <p>Of the enrolled 3013 patients with HCC with CSPH, 342 (11.4%), 1056 (35.0%) and 1615 (53.6%) underwent ablation, liver resection (LR), and transarterial chemoembolization (TACE), respectively. The preliminary analysis indicated that&#xa0;a&#xa0;substantial level of heterogeneity existed within the entire population, while LR possessed the acceptable short-term safety and rendered a&#xa0;potential&#xa0;trend&#xa0;toward a survival&#xa0;benefit over interventional treatments after adjustment for confounding covariates. After we classified the patients on the basis of tumor burden, the distinct advantages of LR over interventional treatments concerning overall survival and disease-free&#xa0;survival were confirmed, and these advantages were coincident among all subset analyses and personalized treatment allocation analyses.</p> Conclusions <p>Both surgical&#xa0;and&#xa0;interventional&#xa0;treatments could offer survival benefits for patients with HCC with CSPH, while LR provided a notable survival&#xa0;advantage in comparison to interventional therapies, even in patients classified as having intermediate or advanced-stage HCC. LR should be prioritized if it is amenable rather than contraindicated.</p>

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Identifying the Optimal Treatment for Patients with Hepatocellular Carcinoma and Clinically Significant Portal Hypertension: A Multicenter Propensity Score-Weighted Analysis

  • 期刊论文

  • 发表日期：

    2025年11月15日

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  • Shoujie Zhao,
  • Jinming Zhu,
  • Yejing Zhu,
  • Jia Jia,
  • Weirong Ren,
  • Enxin Wang,
  • Jun Zhu,
  • Luo Zuo,
  • Liangzhi Wen,
  • Xing Chen,
  • Man Yang,
  • Bo Wang,
  • Jing Li,
  • Jiahao Fan,
  • Yan Zhao,
  • Xingshun Qi,
  • Wenbing Wu,
  • Lei Liu

摘要

Background

Portal hypertension restricts the available therapeutic choices for hepatocellular carcinoma (HCC), adversely impacting patients’ prognosis. Established guidelines regarding the treatment of patients with clinically significant portal hypertension (CSPH) are still a matter of debate. This study aimed to evaluate the therapeutic outcomes and identify the optimal treatment strategy for such a population.

Materials and Methods

The Kaplan–Meier method was utilized for survival analyses. The inverse probability of treatment weighting and multivariate Cox regression models were implemented to adjust for confounding covariates. The relationships between prognostic index and observation end points were evaluated using restricted cubic spline curves.

Results

Of the enrolled 3013 patients with HCC with CSPH, 342 (11.4%), 1056 (35.0%) and 1615 (53.6%) underwent ablation, liver resection (LR), and transarterial chemoembolization (TACE), respectively. The preliminary analysis indicated that a substantial level of heterogeneity existed within the entire population, while LR possessed the acceptable short-term safety and rendered a potential trend toward a survival benefit over interventional treatments after adjustment for confounding covariates. After we classified the patients on the basis of tumor burden, the distinct advantages of LR over interventional treatments concerning overall survival and disease-free survival were confirmed, and these advantages were coincident among all subset analyses and personalized treatment allocation analyses.

Conclusions

Both surgical and interventional treatments could offer survival benefits for patients with HCC with CSPH, while LR provided a notable survival advantage in comparison to interventional therapies, even in patients classified as having intermediate or advanced-stage HCC. LR should be prioritized if it is amenable rather than contraindicated.