Background: D'Amico et al. proposed a portal hypertension (PHT)-staging system for patients with
liver cirrhosis, which was acknowledged by the Baveno IV consensus workshop on methodology
of diagnosis and therapy in PHT.
Here, we investigated the prognostic impact of this PHT-staging system in patients
with cirrhosis and hepatocellular carcinoma (HCC).
Methods: Patients with liver cirrhosis diagnosed with HCC between 1994 and 2012 treated with
non-surgical therapies at the Medical University of Vienna were included (n = 790).
The PHT staging system (stage 1: no ascites/varices, stage 2: varices/no ascites;
stage 3: ascites ± varices; stage 4: bleeding ± ascites) and several other clinically
important parameters of liver function and tumor load were entered into univariate
analysis. Variables with a p-value < 0.05 were included into a multivariate cox-regression
model.
Additionally, the prognostic role of beta-blocker (BB) therapy was investigated in
patients with PHT-stage> 1.
Results: The PHT staging system was significantly associated with overall survival (OS) on
univariate analysis and remained a significant prognostic factor upon multivariate
analysis independent from BCLC stage, Child-Pugh stage, CRP-levels, MELD-score and
tumor load. The median OS for PHT-stage 1/2/3/4 was 22/14/4/6 months (p < 0.001).
Of 585 patients with PHT-stage> 1, only 179 received betablocker-therapy which was
associated with better median OS. (BB vs. no BB: 10.2 vs. 5.8 months, p = 0.026).
Conclusion: The Baveno IV PHT staging system was an independent prognostic factor in patients
with HCC. We noticed a severe under usage of BB in patients with portal hypertension
and HCC. Patients who received BB had a significant better outcome than those without
BB.
