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Updated: Jan 11, 2026
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
Identifying the Optimal Treatment for Patients with Hepatocellular Carcinoma and Clinically Significant Portal
Shoujie Zhao1, Jinming Zhu2, Yejing Zhu1
1State Key Laboratory of Holistic Intergrative Management of Gastrointestinal Cancers and Xijng Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
Background:
Portal hypertension restricts the available therapeutic choices for hepatocellular carcinoma (HCC), adversely impacting patients' prognosis. Established guidelines regarding the treatment of patients with clinically significant portal hypertension (CSPH) are still a matter of debate. This study aimed to evaluate the therapeutic outcomes and identify the optimal treatment strategy for such a population.
Materials And Methods:
The Kaplan-Meier method was utilized for survival analyses. The inverse probability of treatment weighting and multivariate Cox regression models were implemented to adjust for confounding covariates. The relationships between prognostic index and observation end points were evaluated using restricted cubic spline curves.
Results:
Of the enrolled 3013 patients with HCC with CSPH, 342 (11.4%), 1056 (35.0%) and 1615 (53.6%) underwent ablation, liver resection (LR), and transarterial chemoembolization (TACE), respectively. The preliminary analysis indicated that a substantial level of heterogeneity existed within the entire population, while LR possessed the acceptable short-term safety and rendered a potential trend toward a survival benefit over interventional treatments after adjustment for confounding covariates. After we classified the patients on the basis of tumor burden, the distinct advantages of LR over interventional treatments concerning overall survival and disease-free survival were confirmed, and these advantages were coincident among all subset analyses and personalized treatment allocation analyses.
Conclusions:
Both surgical and interventional treatments could offer survival benefits for patients with HCC with CSPH, while LR provided a notable survival advantage in comparison to interventional therapies, even in patients classified as having intermediate or advanced-stage HCC. LR should be prioritized if it is amenable rather than contraindicated.
