Impact of clinically evident portal hypertension on clinical outcome of patients with hepatocellular carcinoma treated by transarterial chemoembolization

Background and Aim: The aim of this study is to determine the impact of clinically evident portal hypertension (CEPH) on prognosis of hepatocellular carcinoma (HCC) patients with Child–Pugh A cirrhosis who underwent transarterial chemoembolization (TACE). Methods: A retrospective data analysis was performed for a total of 388 treatment-naïve HCC patients with Child–Pugh A cirrhosis who underwent TACE as first-line treatment from January 2000 to June 2014. Cumulative occurrence rate of complete response (CR), progression-free survival (PFS), and overall survival (OS) were compared between patients with CEPH and those without CEPH (esophageal/gastric varices or low platelet count [< 100 000 per mm³] associated with splenomegaly). Results: Among 388 patients, 252 (64.9%) had CEPH, while 136 (35.1%) had no evidence of CEPH at the time of HCC diagnosis. Cumulative probability of the occurrence of CR was significantly lower in patients with CEPH than that in patients without CEPH (P < 0.001). Median PFS was significantly shorter in patients with CEPH than that in patients without CEPH (5 vs 31 months, P < 0.001). Five-year OS rate was significantly lower in patients with CEPH than that in patients without CEPH (41.5% vs 77.5%, P < 0.001). Multivariate analysis indicated that the presence of CEPH was the most powerful poor prognostic factor for the occurrence of CR (adjusted hazard ratio [aHR], 0.16; 95% confidence interval [CI], 0.09–0.28; P < 0.001), PFS (aHR, 5.01; 95% CI, 3.08–8.12; P < 0.001), and OS (aHR, 2.95; 95% CI, 1.66–5.23; P < 0.001). Conclusions: The presence of CEPH should be considered as a major negative prognostic factor for patients with HCC who will undergo TACE.