HVPG signature: A prognostic and predictive tool in hepatocellular carcinoma

Area of Science:

• Hepatology
• Oncology
• Gastroenterology

Background:

• Hepatic venous pressure gradient (HVPG) measurement is a key prognostic indicator in cirrhosis.
• The role of HVPG in hepatocellular carcinoma (HCC) prognosis and treatment selection is increasingly recognized.
• Current guidelines (EASL, AASLD) use HVPG≥10 mmHg as a contraindication for hepatic resection (HR) in HCC patients.

Purpose of the Study:

• To explore the prognostic and predictive value of HVPG in patients with cirrhosis and HCC.
• To evaluate whether HVPG≥10 mmHg should be an absolute contraindication for HR in HCC.
• To discuss the ongoing debate regarding direct versus surrogate HVPG measurement methods.

Main Methods:

• Review of current literature on HVPG measurement in cirrhosis and HCC.
• Analysis of studies reporting the impact of HVPG on HCC prognosis, hepatic resection, and liver transplantation.
• Consideration of diagnostic methods for HVPG assessment.

Main Results:

• Elevated HVPG (diagnosed directly or indirectly) is associated with a negative prognosis in HCC patients with cirrhosis.
• HVPG≥10 mmHg may not represent an absolute contraindication for HR in all HCC patients.
• Limited data exists on HVPG's impact post-liver transplantation (LT) and in predicting HCC development, requiring further validation.

Conclusions:

• HVPG is a significant prognostic factor in HCC patients with cirrhosis.
• The strict contraindication of HR based solely on HVPG≥10 mmHg warrants re-evaluation.
• Further research is needed to clarify HVPG measurement methods, its role after LT, and its predictive value for HCC development.