Prognostic impact of the BAVENO IV staging system of portal hypertension in patients with cirrhosis and hepatocellular carcinoma

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.