Table 1_Application of propensity score matching in prognostic analysis of portal hypertension in hepatocellular carcinoma patients.xlsx

ObjectiveTo investigate the impact of portal hypertension on surgical prognosis after hepatectomy for hepatocellular carcinoma and assess the therapeutic value of concomitant splenic modulation procedures.
MethodsWe retrospectively analyzed HCC patients who underwent open hepatectomy with intraoperative portal venous pressure (PVP) measurement at our center between January 2013 and January 2020. Portal hypertension (PHT) was defined as PVP ≥ 25 cm H2O. Patients were categorized as PHT (n = 88) or non-PHT (n = 642). Propensity score matching (1:1) was performed to balance baseline covariates; matched analyses included 59 pairs. Short-term perioperative outcomes and long-term overall survival (OS) and recurrence-free survival (RFS) were compared between groups. Within the PHT cohort, outcomes were compared between hepatectomy alone and hepatectomy combined with splenectomy or splenic artery ligation.
ResultsPost-PSM analysis (59 matched pairs) revealed worse short-term outcomes in the PHT group: shorter surgical duration (p < 0.05) but greater intraoperative blood loss (anatomical/extensive hepatectomy subgroups, p < 0.01), higher postoperative bilirubin levels (p < 0.05), and longer hospital stay (non-anatomical/non-extensive hepatectomy subgroups, p < 0.01). Long-term OS and RFS showed no differences between groups pre- or post-PSM (p > 0.05). However, subgroup analyses demonstrated superior RFS in non-PHT patients undergoing non-anatomical and non-extensive hepatectomy (p = 0.035/0.034). Notably, pre-PSM data indicated improved RFS and OS in PHT patients receiving concomitant splenectomy or splenic artery ligation versus hepatectomy alone (p < 0.001).
ConclusionCompared with non-PHT patients, PHT was not associated with additional risk factors for poor prognosis after surgery. However, PHT may represent a significant risk indicator for recurrence in HCC patients undergoing non-anatomical or non-extensive hepatectomy. Furthermore, for HCC patients with concomitant PHT, hepatectomy combined with splenic artery ligation or splenectomy was associated with better long-term survival.

研究目的：探讨门静脉高压（portal hypertension, PHT）对肝细胞癌（hepatocellular carcinoma, HCC）患者肝切除术后手术预后的影响，并评估联合脾脏调控术式的治疗价值。
研究方法：回顾性分析2013年1月至2020年1月于本中心接受开放肝切除术且术中测量门静脉压力（portal venous pressure, PVP）的HCC患者。以PVP≥25cm H₂O作为门静脉高压的诊断标准，将患者分为门静脉高压组（n=88）与非门静脉高压组（n=642）。采用1:1倾向得分匹配（propensity score matching, PSM）均衡两组基线协变量，匹配后共得到59对匹配病例。比较两组的短期围手术期结局，以及长期总生存期（overall survival, OS）与无复发生存期（recurrence-free survival, RFS）。在门静脉高压队列中，进一步对比单纯肝切除术、肝切除术联合脾切除术或脾动脉结扎术的患者结局差异。
研究结果：倾向得分匹配分析（59对匹配病例）结果显示，门静脉高压组短期结局更差：手术时长更短（p<0.05），但解剖性/大范围肝切除术亚组的术中失血量更多（p<0.01），术后胆红素水平更高（p<0.05），而非解剖性/小范围肝切除术亚组的术后住院时间更长（p<0.01）。PSM前后，两组的长期OS与RFS均无显著差异（p>0.05）。但亚组分析显示，接受非解剖性及非大范围肝切除术的非门静脉高压患者，其RFS更优（p=0.035/0.034）。值得注意的是，PSM前数据表明，相较于单纯肝切除术，门静脉高压患者接受联合脾切除术或脾动脉结扎术可获得更优的RFS与OS（p<0.001）。
研究结论：与非门静脉高压患者相比，门静脉高压并非肝细胞癌肝切除术后不良预后的额外危险因素。但对于接受非解剖性或非大范围肝切除术的HCC患者，门静脉高压可能是肿瘤复发的重要风险指标。此外，对于合并门静脉高压的HCC患者，肝切除术联合脾动脉结扎术或脾切除术可带来更优的长期生存获益。