THE IMPACT OF PORTAL HYPERTENSION ON THE PROGNOSIS AFTER LIVER RESECTION IN CIRRHOTIC PATIENTS WITH HEPATOCELLULAR CARCINOMA

초록

Background: According to recent practice guideline for hepatocellular carcinoma (HCC), surgical resection is generally not recommended for HCC patients with portal hypertension (PHT). Hence, we investigated the impact of PHT on the prognosis after liver resection in cirrhotic HCC patients with relatively preserved liver function. Methods: Of HCC patients who received curative surgical resection between January 2000 and December 2009, 80 Child-Pugh A liver cirrhosis (LC) patients which was confirmed by histology were enrolled for this study. PHT was defined as the presence of varices or platelet count ≤100,000mm3 and splenomegaly. We retrospectively analysed clinical characteristics, postoperative complications (increase Child-Pugh ≥2, prothrombin time-INR ≥1.5, bilirubin ≥3mg/dl,developed or aggravated ascites, postoperative bleeding and mortality), tumor recurrence and survival. Results: Of 80 patients, 24 patients had PHT. The median follow-up duration was 28.2 months (range:0.1-117.3). Sex, age, underlying etiology, baseline laboratory data, operation time, tumor size, pathologic grade, vascular invasion, AJCC stage, perioperative transfusion, postoperative hospital stay were not significantly different between two groups. Model for end-stage liver disease(MELD) score was significantly high (8.2 vs 7.3, p<0.001), single tumor (100% vs 80.6%, p=0.028), major resection (33.3%vs 10.7%, p=0.024) and postoperative complications (70.8%vs 39.3%, p=0.01) were more frequent in patients with PHT. There was no case of liver failure. Although the risk factors of postoperative complications in univariate analysis were male, PHT, major resection, tumor size, baseline albumin, male was the only significant risk factor in multivariate analysis (95%CI:1.414-208.188, p=0.026). Median duration of tumor recurrence was 15.6 months (range:1.6-76.8). Tumor recurrence rate was not different between patients with and without PHT(50% vs 39%, p=0.37). The survival rate at 1 year, 3 years, 5 years with or without PHT was 95%, 74%, 74% and 98%,92%, 84%, respectively (p=0.211). The significant factors associated with survival in univariate analysis were baseline αFP,major resection, transfusion, postoperative complications, but transfusion was the only significant factor in multivariate analysis (95% CI:1.258-35.776, p=0.026). Conclusion: In HCC patients with Child-Pugh A LC, PHT induced more postoperative complications. However, PHT was not associated with tumor recurrence and survival rate after surgical resection. Therefore, surgical resection could be considered for treatment of HCC patients with PHT, especially in Child-Pugh A LC patients.