Management of small hepatocellular carcinoma in cirrhosis: Focus on portal hypertension

Table 1 Relevant reported studies describing the impact of hepatic venous pressure gradient or portal-hypertension related variables in patients with potentially resectable or resected hepatocellular carcinoma

Ref.	Patients included (n)	Portal hypertension-related variables studied	Outcome
Llovet et al[3]	43	HVPG	CSPH independently associated with 5-yr post-operative mortality
Bruix et al[12]	29	HVPG	CSPH independently associated with PLF at 3-mo
Berzigotti et al[13]	63	Spleen size; platelet count; platelet count/spleen diameter; liver stiffness; LSPS PH risk score	Best single predictor of CSPH: liver stiffness; combination with spleen size and platelet count improved the results (AUROC LSPS 0.852; PH risk score 0.884)
Boleslawski et al[14]	43	HVPG Platelet count; spleen size; esophageal varices = indirect signs of PH	CSPH independently associated with increased PLF and 90-d mortality. Indirect signs of PH showed no discriminative ability
Capussotti et al[15]	217	Platelet count; spleen size; esophageal varices	PH associated with lower 3-yr and 5-yr survival
Cescon et al[16]	90	Liver stiffness; platelet count; spleen size; esophageal varices	LS (but not other signs) independently associated with the risk of PLF
Chen et al[17]	190	Intraoperative measurement of PVP	PVP independently associated with PLF on multivariate analysis
Cucchetti et al[18]	241	Platelet count; spleen size; esophageal varices	PH associated with lower 3-yr and 5-yr survival, but not after adjusting for MELD, albumin and extent of resection no
Figueras et al[19]	39	HVPG	CSPH associated with increased risk of morbidity
Giuliante et al[20]	588	Platelet count; spleen size; esophageal varices	PH independently associated with increased mortality
Imamura et al[21]	532	Varices, hypersplenism or hepatofugal portal flow	PH associated with a higher risk of post-operative ascites
Ishizawa et al[22]	203	Platelet count	Platelet count < 100 × 103/mL independently associated with PLF
Kim et al[23]	72	Liver stiffness	LS predicted PLF with good accuracy; LS better than ICG15
Llop et al[24]	79	Liver stiffness	CSPH predicted with good accuracy
Ishizawa et al[25]	434	Platelet count; spleen size; esophageal varices	PH associated with lower 3-yr and 5-yr survival

HVPG: Hepatic venous pressure gradient; PH: Portal hypertension; LS: Liver stiffness; PVP: Portal vein pressure; PLF: Post-operative liver failure; CSPH: Clinically significant PH (HVPG ≥ 10 mmHg); AUROC: Area under receiver operating characteristic curve; MELD: Model for end-stage liver disease.

Table 2 Randomized controlled trials comparing surgical resection and percutaneous ablation in patients with early hepatocellular carcinoma

Ref.	Treatment allocation	Sample size (n)	Serum bilirubin	Tumor median size	Nodules	Median follow-up	Recurrence rate	1/3/5 yr survival
Chen et al[17]	Multidisciplinary team of doctors	90 (resection)	> 2 mg/dL (33%)	< 3 cm (52%)	Single (100%)	NR	NR	94%/68%/NR
		71 (ablation)	> 2 mg/dL (26%)	< 3 cm (46%)	Single (100%)	NR	NR	93%/73%/NR
Huang et al[66]	Consecutive enrolment	38 (ablation)	NR	≤ 2 cm (55%)/2-3 cm (45%)	Single (79%)	37.7 ± 14.5	47%	100%/95%/92%
		38 (resection)	NR	≤ 2 cm (63%)/2-3 cm (37%)	Single (89%)	38.4 ± 16.4	39%	97%/89%/87%
Huang et al[67]	Consecutive enrolment	115 (ablation)	15.3 ± 4.6 μmol/L	≤ 3 cm (49%)	Single (73%)	NR	63%	86.9%/69.6%/54.78%
		115 (resection)	16.4 ± 5.3 μmol/L	≤ 3 cm (39%)	Single (84%)	NR	41%	98.26%/92.17%/75.6%
Feng et al[68]	Consecutive enrolment	84 (ablation)	17.2 μmol/L	≤ 2 cm (37%)/> 2 cm and < 4 cm (63%)	Single (57%)	NR	42%	96%/87.6%/NR
		84 (resection)	15.1 μmol/L	≤ 2 cm (30%)/> 2 cm and < 4 cm (46%)	Single (62%)	NR	32%	93.1%/83.1%/NR

NR: Not reported.