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Hepatic resection for hepatocellular carcinoma in patients with portal hypertension: a long-term benefit compared with transarterial chemoembolization and thermal ablation.

Xiao H, Zhang B, Mei B, Zuo C, Wei G, Wang R, Zhang B, Chen X - Medicine (Baltimore) (2015)

Bottom Line: The short-term and long-term outcomes of liver function, operative mortality and morbidity, and survival rate were compared.Baseline characteristics were similar among the 3 groups, except for patients in the PHT-R group had larger spleen (16.0 vs 11.4 cm, P = 0.001) and smaller tumor size (4.8 vs 7.1 cm, P = 0.001) in comparison with those in the NPHT-R group.The PHT-R group had better liver function compared with those in the PHT-O group (patients had Child-Turcotte-Pugh class B liver function: 5.2% vs 31%, P = 0.001).There was no significant difference of operative mortality and morbidity in all groups.

View Article: PubMed Central - PubMed

Affiliation: From the Hepatic Surgery Center (HX, Binhao Z, BM, GW, RW, Bixiang Z, XC), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Department of Gastroduodenal and Pancreatic Surgery (HX, CZ), the Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China.

ABSTRACT
The optimal treatment for hepatocellular carcinoma (HCC) in cirrhotic patients with portal hypertension (PHT) is still controversial. The objective of this study is to compare HCC patients with PHT treated with hepatic resection to those treated with transarterial chemoembolization (TACE) or thermal ablation. A series of 167 cirrhotic patients with HCC undergoing hepatic resection or TACE/ablation from 2001 to 2008 were retrospectively analyzed. Cirrhotic patients with HCC were divided into 3 groups: hepatic resection in HCC patients with PHT (PHT-R group, n = 58), without PHT (NPHT-R group, n = 67), and TACE or thermal ablation in HCC patients with PHT (PHT-O group, n = 42). The short-term and long-term outcomes of liver function, operative mortality and morbidity, and survival rate were compared.Baseline characteristics were similar among the 3 groups, except for patients in the PHT-R group had larger spleen (16.0 vs 11.4 cm, P = 0.001) and smaller tumor size (4.8 vs 7.1 cm, P = 0.001) in comparison with those in the NPHT-R group. The PHT-R group had better liver function compared with those in the PHT-O group (patients had Child-Turcotte-Pugh class B liver function: 5.2% vs 31%, P = 0.001). There was no significant difference of operative mortality and morbidity in all groups. The 1-, 3-, 5-year survival rates were 80.4%, 55.6%, and 28.1% in the PHT-R group; 79.1%, 64.2%, and 39.8% in the NPHT-R group (vs PHT-R, P = 0.313); and 60.7%, 24.4%, and 7.3% in the PHT-O group (vs PHT-R, P < 0.001). Hepatic resection shows better long-term results for cirrhotic HCC patients with PHT than TACE and thermal ablation.

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Related in: MedlinePlus

Overall survival curves of 167 cirrhotic patients undergoing liver resection for hepatocellular carcinoma with (PHT-R group) or without portal hypertension (NPHT-R group), and those with portal hypertension but performed other treatments (PHT-O group) (Kaplan–Meier method, long-rank test, P = 0.313 between PHT-R and NPHT-R groups; P < 0.001 between PHT-R and PHT-O groups; P < 0.001 between NPHT-R and PHT-O groups).
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Figure 1: Overall survival curves of 167 cirrhotic patients undergoing liver resection for hepatocellular carcinoma with (PHT-R group) or without portal hypertension (NPHT-R group), and those with portal hypertension but performed other treatments (PHT-O group) (Kaplan–Meier method, long-rank test, P = 0.313 between PHT-R and NPHT-R groups; P < 0.001 between PHT-R and PHT-O groups; P < 0.001 between NPHT-R and PHT-O groups).

Mentions: Patients with preoperative PHT who were performed hepatic surgery had similar 1-, 3-, and 5-year survival rates compared with those without PHT: 80.4% and 79.1%, 55.6% and 64.2%, and 28.1% and 39.8%, respectively (P = 0.313), which were significantly better than those treated with TACE or thermal ablation (60.7%, 24.4%, and 7.3%, respectively, P < 0.001) (Figure 1). As shown in Figure 2, tumor-free survivals were also comparable in the PHT-R and NPHT-R groups (P = 0.258).


Hepatic resection for hepatocellular carcinoma in patients with portal hypertension: a long-term benefit compared with transarterial chemoembolization and thermal ablation.

Xiao H, Zhang B, Mei B, Zuo C, Wei G, Wang R, Zhang B, Chen X - Medicine (Baltimore) (2015)

Overall survival curves of 167 cirrhotic patients undergoing liver resection for hepatocellular carcinoma with (PHT-R group) or without portal hypertension (NPHT-R group), and those with portal hypertension but performed other treatments (PHT-O group) (Kaplan–Meier method, long-rank test, P = 0.313 between PHT-R and NPHT-R groups; P < 0.001 between PHT-R and PHT-O groups; P < 0.001 between NPHT-R and PHT-O groups).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554177&req=5

Figure 1: Overall survival curves of 167 cirrhotic patients undergoing liver resection for hepatocellular carcinoma with (PHT-R group) or without portal hypertension (NPHT-R group), and those with portal hypertension but performed other treatments (PHT-O group) (Kaplan–Meier method, long-rank test, P = 0.313 between PHT-R and NPHT-R groups; P < 0.001 between PHT-R and PHT-O groups; P < 0.001 between NPHT-R and PHT-O groups).
Mentions: Patients with preoperative PHT who were performed hepatic surgery had similar 1-, 3-, and 5-year survival rates compared with those without PHT: 80.4% and 79.1%, 55.6% and 64.2%, and 28.1% and 39.8%, respectively (P = 0.313), which were significantly better than those treated with TACE or thermal ablation (60.7%, 24.4%, and 7.3%, respectively, P < 0.001) (Figure 1). As shown in Figure 2, tumor-free survivals were also comparable in the PHT-R and NPHT-R groups (P = 0.258).

Bottom Line: The short-term and long-term outcomes of liver function, operative mortality and morbidity, and survival rate were compared.Baseline characteristics were similar among the 3 groups, except for patients in the PHT-R group had larger spleen (16.0 vs 11.4 cm, P = 0.001) and smaller tumor size (4.8 vs 7.1 cm, P = 0.001) in comparison with those in the NPHT-R group.The PHT-R group had better liver function compared with those in the PHT-O group (patients had Child-Turcotte-Pugh class B liver function: 5.2% vs 31%, P = 0.001).There was no significant difference of operative mortality and morbidity in all groups.

View Article: PubMed Central - PubMed

Affiliation: From the Hepatic Surgery Center (HX, Binhao Z, BM, GW, RW, Bixiang Z, XC), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Department of Gastroduodenal and Pancreatic Surgery (HX, CZ), the Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China.

ABSTRACT
The optimal treatment for hepatocellular carcinoma (HCC) in cirrhotic patients with portal hypertension (PHT) is still controversial. The objective of this study is to compare HCC patients with PHT treated with hepatic resection to those treated with transarterial chemoembolization (TACE) or thermal ablation. A series of 167 cirrhotic patients with HCC undergoing hepatic resection or TACE/ablation from 2001 to 2008 were retrospectively analyzed. Cirrhotic patients with HCC were divided into 3 groups: hepatic resection in HCC patients with PHT (PHT-R group, n = 58), without PHT (NPHT-R group, n = 67), and TACE or thermal ablation in HCC patients with PHT (PHT-O group, n = 42). The short-term and long-term outcomes of liver function, operative mortality and morbidity, and survival rate were compared.Baseline characteristics were similar among the 3 groups, except for patients in the PHT-R group had larger spleen (16.0 vs 11.4 cm, P = 0.001) and smaller tumor size (4.8 vs 7.1 cm, P = 0.001) in comparison with those in the NPHT-R group. The PHT-R group had better liver function compared with those in the PHT-O group (patients had Child-Turcotte-Pugh class B liver function: 5.2% vs 31%, P = 0.001). There was no significant difference of operative mortality and morbidity in all groups. The 1-, 3-, 5-year survival rates were 80.4%, 55.6%, and 28.1% in the PHT-R group; 79.1%, 64.2%, and 39.8% in the NPHT-R group (vs PHT-R, P = 0.313); and 60.7%, 24.4%, and 7.3% in the PHT-O group (vs PHT-R, P < 0.001). Hepatic resection shows better long-term results for cirrhotic HCC patients with PHT than TACE and thermal ablation.

Show MeSH
Related in: MedlinePlus