Role of post-hepatectomy portal hypertension in predicting the outcome of hepatocellular carcinoma after curative resection

Aims: Portal venous pressure frequently increases after a major hepatectomy. We aimed to assess the outcomes of patients with hepatocellular carcinoma (HCC) with different post-hepatectomy portal pressure statuses and the predictive factors correlated with prognosis and post-hepatectomy portal hypertension (PHPH). Methods: Data from consecutive patients who underwent curative-intent hepatectomy for HCC at the Eastern Hepatobiliary Surgery Hospital and Mengchao Hepatobiliary Hospital of Fujian Medical University between January 2008 and December 2016 were retrospectively analyzed. Patients were followed up until March 1, 2022. PHPH was defined as new-onset portal hypertension (PH) in patients without preoperative PH within 1 month of hepatectomy. Patients were classified into two groups according to the presence or absence of PHPH: non-PH and PHPH. The clinicopathological characteristics were compared between the two groups. Univariate and multivariate analyses were used to identify independent risk factors for early and late recurrence of HCC, overall survival (OS), and PHPH. Results: Disease-free survival rates were significantly higher in the non-PH group (n = 1068) than those in the PHPH group (n = 423) (62.0%, 39.0%, and 31.0% vs. 46.2%, 24.5%, and 19.3% at 1, 3, and 5 years, respectively; all p < 0.001). The 1-, 3-, and 5-year OS rates were 91.0%, 66.4%, and 51.4% in the non-PH group and 80.0%, 48.9%, and 32.6% in the PHPH group, respectively (all p < 0.001). Multivariate analysis revealed that PHPH was independently associated with early recurrence of HCC and poor OS (hazard ratio [HR] 1.476, 95% confidence interval [CI] 1.279-1.704, p < 0.001 and HR 1.601, 95% CI 1.383-1.853, p < 0.001, respectively). Furthermore, hepatitis B virus infection, cirrhosis, preoperative alanine aminotransferase > 40 U/L, and major hepatectomy were identified as independent risk factors for PHPH. Conclusions: PHPH was associated with early recurrence of HCC and poor OS but not with late recurrence. Therefore, PHPH may be an attractive target for therapeutic interventions and follow-up surveillance to improve prognosis.