Impact of clinically significant portal hypertension on outcomes after partial hepatectomy for hepatocellular carcinoma: a systematic review and meta-analysis

Liu, Jianwei; Zhang, Han; Xia, Yong; Yang, Tian; Gao, Yinghong; Li, Jun; Wu, Yeye; Shen, Feng

doi:10.1016/j.hpb.2018.07.005

Cited by 31 publications

(24 citation statements)

References 44 publications

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“…And it was expected to be able to give a chance for better long-term OS and DFS ( 21 ). A meta-analysis and review indicated that portal hypertension had an adverse impact on short- and long-term outcomes for HCC patients undergoing partial hepatectomy ( 22 ). Meanwhile, liver cirrhosis was considered as one of the most important risk factors for surgical outcomes in HCC patients ( 3 , 16 , 23 , 24 ).…”

Section: Discussionmentioning

confidence: 99%

Sub-Classification of Cirrhosis Affects Surgical Outcomes for Early Hepatocellular Carcinoma Independent of Portal Hypertension

Zhang

Jiang

et al. 2021

Front. Oncol.

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Severity of liver cirrhosis is distinct from clinical portal hypertension because there exist different degrees of liver cirrhosis in hepatocellular carcinoma (HCC) patients without significant clinical portal hypertension. Whether severity of cirrhosis affects surgical outcomes for HCC patients in absence of portal hypertension or not remains unclear. This study aims to analyze the effect of cirrhotic severity on surgical outcomes for HCC patients with hepatitis B virus (HBV) infection in absence of portal hypertension. This retrospective study enrolled 166 patients who underwent curative resection for a single HCC ≤5 cm in absence of portal hypertension between February 2011 and December 2013. Liver cirrhosis was sub-classified into no/mild (no/F4A) and moderate/severe (F4B/F4C) according to the Laennec scoring system. The surgical outcomes and complications were analyzed. The surgical mortality was zero in this study. Major complications were apparently higher in the F4B/F4C group than in the no/F4A group (17.0% vs 7.4%, p <0.001). The 1-year, 3-year and 5-year overall survival (OS) rates were 98.5, 88.1 and 80%, respectively, in the no/F4A group, which were significantly higher than those in the F4B/F4C group (98.0, 69.2 and 54.7%, p = 0.001). Microscopic vascular invasion, absence of tumor capsule and severity of liver cirrhosis were independent risk factors of surgical outcomes for HCC patients without portal hypertension. In conclusion, severity of liver cirrhosis affected surgical outcomes for early-stage HCC patients independent of portal hypertension.

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Section: Discussionmentioning

confidence: 99%

Sub-Classification of Cirrhosis Affects Surgical Outcomes for Early Hepatocellular Carcinoma Independent of Portal Hypertension

Zhang

Jiang

et al. 2021

Front. Oncol.

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“…[33,34] Recently, a meta-analysis also confirmed that clinical PH could negatively influence both short-term and long-term outcomes of patients with HCC after liver resection. [35] Accordingly, in the present study, we excluded patients with portal hypertension.…”

Section: Discussionmentioning

confidence: 99%

The preoperative platelet to albumin ratio predicts the prognosis of hepatocellular carcinoma patients without portal hypertension after liver resection

Li¹,

Peng²,

Zhang³

et al. 2019

Medicine

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There is little information concerning the predictive ability of the preoperative platelet to albumin ratio (PAR) in hepatocellular carcinoma (HCC) patients after liver resection. In the current study, we aimed to assess the prognostic power of the PAR in HCC patients without portal hypertension (PH) following liver resection.Approximately 628 patients were included in this study. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of the PAR for both recurrence-free survival (RFS) and overall survival (OS). Univariate and multivariate analyses were used to identify the independent risk factors for both RFS and OS.During the follow-up period, 361 patients experienced recurrence, and 217 patients died. ROC curve analysis suggested that the best cut-off value of the PAR for RFS was greater than 4.8. The multivariate analysis revealed that microvascular invasion (MVI), tumor size >5 cm, high aspartate aminotransferase-to-platelet count ratio index (APRI) and high PAR were four independent risk factors for both RFS and OS. Patients with a low PAR had significantly better RFS and OS than those with a high PAR.The PAR may be a useful marker to predict the prognosis of HCC patients after liver resection. HCC patients with a high preoperative PAR had a higher recurrent risk and lower long-term survival rate than those with a low preoperative PAR.

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“…However, portal hypertension is inherently associated with deterioration of liver function, and several studies demonstrated that, once patients are stratified according to liver function, portal hypertension is no more an independent prognostic index [114,115,116,117]. Even if the debate is still ongoing, a recent meta-analysis confirmed that indirect signs of portal hypertension (e.g., thrombocytopenia/splenomegaly) are not associated with a worse prognosis following liver resection for HCC [118]. Roayaie et al showed that patients with a low platelet count had lower survival than patients with a normal platelet count, and that survival curves start diverging late (>2 years) after surgery, independently from postoperative recovery [119,120].…”

Section: Prognostic Role Of Platelets In Patients With Hcc Candidamentioning

confidence: 99%

Platelets and Hepatocellular Cancer: Bridging the Bench to the Clinics

Lai

Vitale

Manzia

et al. 2019

Cancers

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Growing interest is recently being focused on the role played by the platelets in favoring hepatocellular cancer (HCC) growth and dissemination. The present review reports in detail both the experimental and clinical evidence published on this topic. Several growth factors and angiogenic molecules specifically secreted by platelets are directly connected with tumor progression and neo-angiogenesis. Among them, we can list the platelet-derived growth factor, the vascular endothelial growth factor, the endothelial growth factor, and serotonin. Platelets are also involved in tumor spread, favoring endothelium permeabilization and tumor cells’ extravasation and survival in the bloodstream. From the bench to the clinics, all of these aspects were also investigated in clinical series, showing an evident correlation between platelet count and size of HCC, tumor biological behavior, metastatic spread, and overall survival rates. Moreover, a better understanding of the mechanisms involved in the platelet–tumor axis represents a paramount aspect for optimizing both current tumor treatment and development of new therapeutic strategies against HCC.

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Impact of clinically significant portal hypertension on outcomes after partial hepatectomy for hepatocellular carcinoma: a systematic review and meta-analysis

Abstract: CSPH had a negative impact on short- and long-term prognoses for HCC patients undergoing partial hepatectomy. However, CSPH did not affect the prognoses in a subgroup of European HCC patients whose CSPH was diagnosed by the standard surrogate criteria.

Cited by 31 publications

References 44 publications

Sub-Classification of Cirrhosis Affects Surgical Outcomes for Early Hepatocellular Carcinoma Independent of Portal Hypertension

Sub-Classification of Cirrhosis Affects Surgical Outcomes for Early Hepatocellular Carcinoma Independent of Portal Hypertension

The preoperative platelet to albumin ratio predicts the prognosis of hepatocellular carcinoma patients without portal hypertension after liver resection

Platelets and Hepatocellular Cancer: Bridging the Bench to the Clinics

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