HVPG and transient elastography are the best prognostic factor in patients with
hepatocellular carcinoma submitted to hepatic resection
Bogdan Procopet1, Emil Mois2, Adelina Horhat1, Anca Bugariu1, Horia Stefanescu1,
Florin Graur 2, Marcel Tantau1, Nadim Al Hajjar2
1. University of Medicine and Pharmacy “Iuliu Hatieganu”, 3rd Medical Clinic,
Gastroenterology Department, Cluj-Napoca, Romania
2. University of Medicine and Pharmacy “Iuliu Hatieganu”, Surgery Department,
Cluj-Napoca, Romania
Background and aims:
Hepatic resection is one of the best curative treatments in well-selected patients with
hepatocellular carcinoma (HCC) and cirrhosis. The risk of decompensation after
resection has major impact over the outcome of these patients. Portal hypertension is
the main risk factor for decompensation and it is still a matter of debate which is the
best method to identify patients at risk.
The aim of the study was to compare different methods for risk assessment in patients
with HCC submitted to hepatic resection.
Patients and methods:
Since January 2016 94 consecutive patients were diagnosed with HCC and were
prospectively registered. Thirty-three patients were submitted to hepatic resection and
among them: 22 were screened for esophageal varices (EV), 13 patients were
evaluated by hepatic venous pressure gradient (HVPG) and 18 by transient
elastography.
Results:
Among the 33 included patients, 8/22 (35%) had EV, 6/13 (46%) had clinical
significant portal hypertension (HVPG>10mmHg) and 9 (30%) had platelet count
<100.000/mmc. During follow-up 12 (36%) patiens presented decompensation (3
variceal bleeding, 7 ascites, 6 renal dysfunction and 1 jaundice). In univariate analysis
HVPG, liver stiffness, platelet count, ALT and AST were associated with
decompensation. Neither presence of EV (40% correctly classified, p=0.13) or platelet
count <100.000/mmc (64% correctly classified, p=0.08) were accurate enough to
predict decompensation. Presence of CSPH assessed by HVPG correctly classified
92% of patients (p=0.002). There was no difference between HVPG and transient
elastography regarding the performances (AUROC) for predicting decompensation,
0.91 (95%CI: 0.74-1, p=0.012) and 0.93 (95%CI: 0.80-1, p=0.007), respectively.
Conclusion:
HVPG is the best prognostic factor for the risk of decompensation after hepatic
resection in patient with HCC and cirrhosis, while surrogate markers, as presence of
EV of low platelet count, is not accurate enough. Liver stiffness measurement with
transient elastography is a promising prognostic tool.