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Predictive factors for long-term survival in patients with clinically significant portal hypertension following resection of hepatocellular carcinoma

 Gi H. Choi  ;  Jun Y. Park  ;  Ho K. Hwang  ;  Dong H. Kim  ;  Chang M. Kang  ;  Jin S. Choi  ;  Young N. Park  ;  Do Y. Kim  ;  Sang H. Ahn  ;  Kwang-Hyub Han  ;  Chae Y. Chon  ;  Woo J. Lee 
 LIVER INTERNATIONAL, Vol.31(4) : 485-493, 2011 
Journal Title
Issue Date
Carcinoma, Hepatocellular/surgery* ; Forecasting/methods* ; Humans ; Hypertension, Portal/complications ; Hypertension, Portal/physiopathology* ; Liver Cirrhosis/physiopathology* ; Liver Neoplasms/surgery* ; Multivariate Analysis ; Postoperative Complications/etiology ; Postoperative Complications/physiopathology* ; Prognosis ; Prothrombin Time ; Republic of Korea ; Survival Analysis
BACKGROUND: Hepatic resection for hepatocellular carcinoma (HCC) is not currently recommended for patients with clinically significant portal hypertension (PHT); however, recent studies have shown similar post-operative outcomes between patients with and without clinically significant PHT.

AIM: To clarify the post-operative prognostic relevance of clinically significant PHT in Child-Pugh A cirrhotic patients.

METHODS: A total of 100 Child-Pugh A cirrhotic patients who underwent curative resection of HCC were eligible for this analysis. Patients were divided into two groups: PHT group (n=47) and non-PHT group (n=53).

RESULTS: Clinicopathological variables showed no significant differences except for prothrombine time. Liver-related complications were significantly higher in the PHT group (P=0.015), and the 5-year overall survival rate was significantly higher in the non-PHT group (78.7 vs. 37.9%, P<0.001). The proportion of patients who died because of complications of cirrhosis was significantly higher in the PHT group (P=0.001). Multivariate analysis indicated that the presence of clinically significant PHT was the most powerful adverse prognostic factor for overall survival. Multivariate analysis of the 47 patients with clinically significant PHT indicated that gross vascular invasion and non-single nodular type were poor prognostic factors. The 5-year survival rate of patients with single nodular type and without gross vascular invasion (n=17) was 78.4%.

CONCLUSIONS: In Child-Pugh A cirrhotic patients, the presence of clinically significant PHT was significantly associated with post-operative hepatic decompensation and poor prognosis after resection of HCC. However, in patients with clinically significant PHT, those with single nodular tumours lacking gross vascular invasion may be good surgical candidates.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Kim, Do Young(김도영)
Park, Young Nyun(박영년) ORCID logo https://orcid.org/0000-0003-0357-7967
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Woo Jung(이우정) ORCID logo https://orcid.org/0000-0001-9273-261X
Chon, Chae Yoon(전재윤)
Choi, Gi Hong(최기홍) ORCID logo https://orcid.org/0000-0002-1593-3773
Choi, Jin Sub(최진섭)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
Hwang, Ho Kyoung(황호경) ORCID logo https://orcid.org/0000-0003-4064-7776
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