Open Radiofrequency Ablation Combined with Splenectomy and Pericardial Devascularization vs. Liver Transplantation for Hepatocellular Carcinoma Patients with Portal Hypertension and Hypersplenism: A Case-Matched Comparative Study

Figures & data

Table 1. Baseline data of the open radiofrequency ablation and splenectomy group and the liver transplantation group.

Variable	Study group (n = 32)	Control group (n = 32)	P^b
Patient characteristics
Number of patients (n)	32	32	–
Age (yr)^a	47.50 (24–63)	46.00 (31–70)	0.627
Gender(Male/Female)	27:5	29:3	0.708
Child-Pugh grade (A:B)	30:2	27:5	0.426
MELD sore^a	9.26 (6.96–12.97)	8.59 (6.4–19.13)	0.358
Preoperative laboratory tests
AFP (ng/mL)^a	90.11 (1.57–892.00)	20.44 (0.67–3,316.00)	0.390
ICG R-15 (%)^a	11.70 (1.30–35.50)	8.90 (1.90–23.50)	0.169
Hemoglobin(HB)^a	106.50 (67.00–141.00)	104.00 (81.00–156.00)	0.845
White cell count(×10^9/L)^a	2.44 (0.95–8.93)	2.83 (1.20–5.12)	0.401
Platelet count(×10^9/L)^a	47.50 (20.00–88.00)	52.00 (27.00–75.00)	0.941
INR^a	1.18 (0.98–1.33)	1.12 (0.88–1.85)	0.072
Albumin^a	38.20 (30.08–51.00)	42.05 (18.50–50.20)	0.097
ALT (IU/L)^a	23.50 (10.10–189.00)	32.00 (12.00–339.60)	0.092
AST(IU/L)^a	34.00 (14.60–305.00)	45.25 (18.00–866.60)	0.116
Serum total bilirubin (g/L)^a	22.30 (7.00–43.60)	20.10 (4.12–349.20)	0.799
APRI^a	0.80 (0.33–4.92)	0.78 (0.17–13.33)	0.254
HBV-DNA level (IU/mL) >200–20,000 >20,000–200,000 >200,000–2,000,000 >2,000,000	28 1 3 0	30 1 0 1	0.238
Tumor characteristics
BCLC staging (A/B)	32/0	32/0	–
TNM classification
I/II	28/4	27/5	1.000
Esophageal varices(yes/no)	31/1	26/6	0.104
History of gastrointestinal bleeding(yes/no)	18/14	12/20	0.133
Tumor location(leTumor location(left/right)	13/19	8/24	0.183
Number of tumors Single More than two	28 4	26 6	0.491
Diameter of tumor (cm)^a	2.90 (0.93–4.90)	2.25 (1.60–5.00)	0.355
Splenomegaly(moderate/severe)	12/20	21/11	0.794
Internal diameter of the main portal vein^a	1.30 (1.01.30 (1.00–1.70)	1.25 (1.00–1.60)	0.496

^aValue expressed in median with range in parentheses.

^bStudy group compared with control group. MELD: Model for End-Stage Liver Disease; AFP,α-fetoprotein; ICG R-15, Indocyanine 15-minute retention rate; INR: international normalized ratio; HBV, hepatitis B virus; ALT, alanine aminotransferase; AST, aspartate aminotransferase; APRI, aspartate aminotransferase to platelet ratio index; BCLC: Barcelona Clinic Liver Cancer.

Figure 1. (A) Intraoperative exploration revealed that the patient’s spleen was seriously enlarged. The spleen enlarged beyond the left subcostal margin. (B) The pericardia vessels were dissected upward for at least 5 cm. (C) The removed spleen was severely enlarged. (D) The RFA needle was inserted into the center of the tumor to initiate the radiofrequency ablation.

Table 2. Intra- and postoperative results of HCC of the open radiofrequency ablation and splenectomy group and the liver transplantation group.

Variable	Study group (n = 32)	Control group (n = 32)	P^b
Operative data
Estimated blood loss (ml)2^a	550 (300–1,500)	800 (300–4,000)	0.017
Volume of bloodVolume of blood transfusion (ml)^a	655 (0–2,200)	795 (0–4,560)	0.653
No need for blood transfusion	19	20	0.798
Postoperative data
Serum total bilirubin (Perioperative maximum g/L)^a	41.50 (22.00–343.80)	56.45 (11.8–425.83)	0.005
Platelet count (Perioperative maximum × 10^9/L)^a	408.00 (56–872)	202.5 (100–482)	<0.001
Portal thrombus	11	5	0.083
Ascites	19	20	0.798
Intraabdominal abscess	2	6	0.257
Pleural effusion	17	29	0.001
Pneumonia	5	18	0.001
Intraabdominal hemorrhage	1	0	–
Hospital mortality	1	0	–
Postoperative stay(d)^a	16 (8–109)	19 (7–180)	0.480
Upper gastrointestinal hemorrhage after operation	5	5	1.000

^aValue expressed in median with range in parentheses.

^bStudy group compared with control group.

Figure 2. (A) Survival curves of DFS for patients with HCC and hypersplenism who were treated with open radiofrequency ablation combined liver splenectomy and pericardial devascularization (n = 32) and liver transplantation (n = 32), P < 0.001 (study group vs. control group; Kaplan–Meier, log–rank test). (B) OS curves of for patients with HCC and hypersplenism who were treated with open radiofrequency ablation combined with splenectomy and pericardial devascularization (n = 32) and liver transplantation (n = 32), P = 0.670 (study group vs. control group; Kaplan–Meier, log–rank test).