Impact of portal hypertension on short‐ and long‐term outcomes after liver resection for intrahepatic cholangiocarcinoma: A propensity score matching analysis

Abstract

OBJECTIVE: We explored the impact of clinically significant portal hypertension (CSPH) on short- and long-term outcomes of intrahepatic cholangiocarcinoma (ICC) after liver resection (LR). METHODS: Data of 352 ICC patients with cirrhosis who underwent LR were extracted from the Primary Liver Cancer Big Data (PLCBD) between 2005 and 2015 and reviewed. A nomogram based on logistic analyses was developed to illustrate the influencing factors of post-hepatectomy liver failure (PHLF). The impact of CSPH on long-term survival was explored through propensity score matching (PSM) analysis, log-rank test, Cox proportional hazards model, and Kaplan-Meier curves. RESULTS: A total of 106 patients had CSPH, and 246 patients did not. A nomogram established based on GGT level, CSPH, intraoperative blood loss, and multiple tumors had an area under the receiver operating characteristic curve of 0.721 (95% confidence interval [CI] = 0.630-0.812), which displayed a better PHLF predictive value than the MELD score (0.639, 95% CI = 0.532-0.747) and Child-Pugh score (0.612, 95% CI = 0.506-0.719). Moreover, the patients with CSPH had worse overall survival (OS) rates than the patients without CSPH in the whole cohort (p = 0.011) and PSM cohort (p = 0.017). After PSM, multivariable Cox analyses identified that CSPH was an independent risk factor for OS (hazard ratio = 1.585, 95% CI = 1.107-2.269; p = 0.012). CONCLUSION: CSPH is a significant risk factor for PHLF and OS in ICC patients with cirrhosis after surgery. Selecting the proper patients before operation can effectively avoid PHLF and improve the prognosis of ICC.