Prevalence and impact of Clinically Significant Portal Hypertension (CSPH) in patients with Hepatocellular Carcinoma (HCC): a multicenter cohort study on the ITA.LI.CA database

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2025-02-01 DOI:10.1016/j.dld.2025.01.097

R. Chen , M. Dibetto Rimondini , E.G. Giannini , V. Santi , F. Pelizzaro , A. Sangiovanni , G. Cabibbo , F. Marra , F.G. Foschi , G. Svegliati-Baroni , F.R. Ponziani , G. Missale , F. Morisco , R. Sacco , G. Ghittoni , C. Saitta , G. Vidili , F. Azzaroli , M.R. Brunetto , S. Boninsegna , F. Piscaglia

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引用次数: 0

Abstract

Background and Aims

Clinically significant portal hypertension (CSPH) is a known independent predictor of hepatocellular carcinoma (HCC) development and prognosis, influencing patient access to oncological treatments. This study aims to evaluate the prevalence of CSPH and its impact across different HCC stages according to the Barcelona Clinic Liver Cancer (BCLC) staging system.

Method

A retrospective analysis was conducted on HCC patients registered in the Italian Liver Cancer (ITA.LI.CA) database between January 1987 and December 2022. Patients in BCLC stage D or stage C without extrahepatic metastasis or macrovascular invasion and those with Child-Pugh score > B7, were excluded. The presence of CSPH was assessed through esophageal/gastric varices, tense ascites, or liver stiffness > 25 kPa.

Results

Of 10,907 total patients, 7,069 were included, with 2,652 diagnosed with CSPH. CSPH prevalence was highest in alcoholic etiology and BCLC stage C (44.7%), followed by stages A (39.1%), B (33.9%), and 0 (19.6%). CSPH correlated with reduced survival overall, particularly in stages A, B, and C in univariate analysis, but not in stage 0. Multivariate analysis confirmed this association for stages A and B, but not for stage C. Only 9.7% of CSPH patients were on non-selective beta-blockers (NSBB), and although NSBB use improved survival in univariate analysis, it did not in multivariate analysis.

Conclusion

This study found that CSPH significantly impacts survival in early and intermediate stages of HCC, but not in very early or advanced stages, likely due to milder liver disease in very early stages (or more frequent access to liver transplantation) or a dominant oncological burden in advanced stages. CSPH is common in advanced HCC patients, who often require anti-angiogenic therapies that necessitate careful management due to the presence of CSPH. Further analysis is underway, including a subgroup analysis of BCLC-C patients based on venous invasion.

查看原文本刊更多论文

肝细胞癌（HCC）患者中临床意义门静脉高压症（CSPH）的患病率和影响：ITA.LI.CA 数据库中的一项多中心队列研究

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.