Transcatheter arterial chemoembolization plus ablation therapy versus liver resection for hepatocellular carcinoma with clinically significant portal hypertension by an inverse probability of treatment weighting analysis.

Clinically significant portal hypertension (CSPH) is an important factor in selecting the therapeutic modality for hepatocellular carcinoma (HCC). We aimed to assess the long-term outcomes of transcatheter arterial chemoembolization combined with ablation therapy (A-TACE) versus liver resection (LR) for HCC patients with CSPH. Data of 307 patients first diagnosed with HCC receiving LR or A-TACE were retrospectively collected from two tertiary hospitals in China between January 2016 and December 2020. To minimize the impact of potential confounders, an inverse probability of treatment weighting (IPTW) analysis was conducted. Additionally, Kaplan-Meier analysis was employed to compare overall survival (OS) and progression-free survival (PFS) across different groups. Among the 229 patients undergoing LR, 38 had CSPH and 191 did not; of the 78 patients receiving A-TACE, there were 43 without CSPH and 35 with CSPH. Regardless of which treatment option, no significant differences in OS and PFS were observed between the CSPH and Non-CSPH groups before and after IPTW. Notably, among HCC patients with CSPH, OS and PFS between those receiving LR and A-TACE were not significantly different after IPTW. To conclude, CSPH is not associated with a worse prognosis of HCC patients after curative operations. For patients with CSPH, A-TACE may provide comparable long-term survival to LR, suggesting that it could be considered a reasonable alternative therapeutic option in this population.