Home The clinical value of the hepatic venous pressure gradient in patients undergoing hepatic resection for hepatocellular carcinoma with or without liver cirrhosis
Article Open Access

The clinical value of the hepatic venous pressure gradient in patients undergoing hepatic resection for hepatocellular carcinoma with or without liver cirrhosis

  • Felix Busch EMAIL logo , Katja N. De Paepe , Paul Gibbs , Michael Allison , Matthew Hoare and Teik Choon See
Published/Copyright: March 8, 2024
Download Article (PDF)
Open Medicine
From the journal Open Medicine Volume 19 Issue 1

Abstract

The role of hepatic venous pressure gradient (HVPG) measurement in risk stratification before liver resection is an ongoing area of debate. This study examines the impact of preoperative HVPG levels on overall survival (OS)/time to recurrence (TTR) and postoperative complications after hepatic resection of hepatocellular carcinoma (HCC). Thirty-eight HCC patients undergoing HVPG measurement before liver resection at Cambridge University Hospitals NHS Foundation Trust between January 2014 and April 2022 were retrospectively analysed. Statistical analysis comprised univariable/multivariable Cox/logistic regression to identify risk factors of reduced OS/TTR or 90-day post-resection complications and Kaplan–Meier estimator, log-rank, chi-squared, Fisher's exact, and Mann–Whitney U test, or Student's t-test for survival/subgroup analysis. The median HPVG was 6 (range: 0–14) mmHg. The HVPG was an independent risk factor for poorer TTR in the overall cohort (cut-off: ≥7.5 mmHg (17.18/43.81 months; P = 0.009)). In the subgroup analysis of cirrhotic patients (N = 29 (76%)), HVPG was additionally an independent risk factor for lower OS (cut-off: ≥8.5 mmHg [44.39/76.84 months; P = 0.012]). The HVPG had no impact on OS/TTR in non-cirrhotic patients (N = 9 (24%)), nor was it associated with postoperative complications in any cohort. In conclusion, preoperative HVPG levels are useful predictors for TTR and OS in cirrhotic HCC patients undergoing hepatic resection.

Keywords: hepatic venous pressure gradient measurement; HCC; advanced chronic liver disease; liver resection; clinically significant portal hypertension

1 Introduction

Advanced chronic liver disease usually leads to increased portal venous pressure due to fibrotic progression of the liver parenchyma, which is associated with life-threatening complications, such as variceal haemorrhage, hepatorenal syndrome, or hepatic encephalopathy [1,2]. The assessment of portal venous pressure is known to be a useful tool for monitoring disease progress and treatment response in patients with chronic liver disease [3].

The hepatic venous pressure gradient (HVPG) measurement is an invasive although safe method for a precise indirect estimation of the portal venous pressure and has therefore become the standard measurement method in recent decades [3,4]. HVPG values of 5–9 mmHg are considered mild portal hypertension and, e.g., are associated with a higher risk of HCV recurrence after liver transplantation [5,6]. Values ≥10 mmHg are categorised as clinically significant portal hypertension (CSPH) and have been linked to the development of hepatocellular carcinoma (HCC), a higher risk of ascites, variceal bleeding, or hepatic encephalopathy in patients with compensated cirrhosis [7,8,9]. A meta-analysis in 2015 of eleven studies with a total of 1,737 included subjects concluded a decreased 3- and 5-year overall survival (OS) in HCC patients with compensated cirrhosis and pre-surgical CSPH as well as an increased risk of liver decompensation in a sub-analysis after liver resection of HCC [10]. However, in this pooled analysis, patients with CSPH had significantly higher bilirubin levels and a higher international normalised ratio and were more often Child-Pugh class B at baseline than non-CSPH patients [11]. In a propensity score matching study, patients with portal hypertension (indirectly assessed by reduced platelet count and splenomegaly or the presence of gastroesophageal varices) with the same model for end-stage liver disease (MELD) score and extent of hepatectomy planning showed no inferior survival or a higher number of postoperative complications [12]. A recent study showed safe postoperative courses and promising 5-year OS and disease-free survival rates of 55 and 43%, respectively, after liver resection of HCC in Child-Pugh A patients with CSPH [13]. In addition, it has been reported that one-quarter of HCC patients who would benefit from surgery are excluded when CSPH is considered a contraindication [14].

Hence, there is an ongoing discourse about the impact of increased preoperative HVPG levels, especially when amounting to CSPH, on postoperative complications and the long-term outcome in HCC patients undergoing liver resection. Moreover, the current literature is still based on small sample sizes, and international guidelines do not recommend the HVPG measurement before resection per se due to the minimally invasive procedure, cost-intensiveness, and the requirement of interventional expertise that is usually only available in large tertiary centres [13,15,16,17]. Finally, no study has separately investigated the impact of HVPG levels on post-resection complications or the long-term outcome for non-cirrhotic patients with HCC.

Therefore, the purpose of this study is to investigate the value of HVPG measurements prior to liver resection in HCC patients with or without cirrhosis, determining the impact of the pre-resection HVPG level on OS, time to recurrence (TTR), 90-day post-resection complications, and hospital length of stay after liver resection of HCC with curative intent.

2 Methods

Institutional approval was obtained for this retrospective study (PRN10518). All subjects gave informed consent prior to HVPG measurement.

2.1 Inclusion and exclusion criteria

This study included patients ≥18 years of age with histologically or radiologically (Liver Imaging Reporting And Data System 5) diagnosed HCC who underwent HVPG measurement prior to liver resection with curative intent at Cambridge University Hospitals NHS Foundation Trust, UK, between January 2014 and April 2022 [18]. Patients with a previous liver resection at the same lesion site or those ultimately not undergoing liver resection after HVPG assessment were excluded from the analysis.

2.2 Study endpoints and parameters

The primary endpoint was to evaluate the impact of the pre-resection HVPG level on OS, TTR, the development of 90-day post-resection complications, and post-resection hospital stay length in HCC patients undergoing liver resection with or without liver cirrhosis. In a subgroup analysis, we compared the same endpoints between patients with and without preoperative CSPH (HVPG values ≥10 mmHg) independently of present cirrhosis. The presence of liver cirrhosis was determined from the pathological reports of liver resection. OS was defined as the time from curative resection to death. TTR was defined as the time from resection to progression of intra- or extrahepatic HCC disease, censoring death without recurrence at the time of death.

In addition, all other obtained basic and disease-specific patient characteristics at baseline were examined on their effect on OS, TTR, 90-day post-resection complications, and hospital stay length (see Table 1). Ascites was graded according to the Consensus Conference of the International Ascites Club [19]. Splenomegaly was defined as a major diameter >10 cm on axial CT or MRI [20]. Additionally included surgical parameters were resection approach, resection extent (minor resection of up to two or major resection of more than two liver segments [21]), and anatomical/non-anatomical resection.

Table 1

Preoperative basic and disease characteristics of the overall cohort and the comparison of patients with/without cirrhosis and patients with/without clinically significant portal hypertension (≥10 mmHg)

Variables Overall cohort (N = 38) Cirrhosis (N = 29) Non-cirrhotic (N = 9) P value comparison HVPG ≥10 mmHg (N = 10) HVPG <10 mmHg (N = 28) P value comparison
Age (years) 66 (40–77) 66 (40–76) 66 (56–77) 0.480 57 (52–72) 66 (40–77) 0.183
Sex (N) 0.396 0.090
 Female 10 9 1 5 5
 Male 28 20 8 5 23
Body mass index (kg/m2)* 28.16 ± 4.92 27.54 ± 4.89 29.97 ± 4.81 0.206 28.12 ± 5 28.17 ± 4.99 0.979
Extrahepatic disease (N) 1.000 1.000
 Bladder cancer 1 1 0 0 1
Number of lesions (N) 1 (1–4) 1 (1–4) 1 (1–2) 1.000 1 (1–3) 1 (1–4) 0.097
Median lesion size (mm) 30 (9.5–110) 25 (9.5–82) 37 (17–110) 0.050 16 (9.5–34.67) 32.75 (11–110) 0.029
Size of largest lesion (mm) 30 (12–110) 25 (12–79) 55 (17–110) 0.004 21 (13–64) 33.5 (12–110) 0.445
UICC staging 8th edition (N) 0.557 0.135
 pT1 a/b 5/2 4/2 1/0 2/2 3/0
 pT2 20 16 4 6 14
 pT3 5 4 1 0 5
 pT4 5 2 3 0 5
 pTx 1 1 0 0 1
 R1 6 5 1 0 6
Histological grading (N) 0.164 0.218
 G1 7 5 2 4 3
 G2 19 17 2 4 15
 G3 11 6 5 2 9
 GX 1 1 0 0 1
Microscopic vascular invasion (N) 27 19 8 0.237 5 22 0.236
Macroscopic vascular invasion (N) 10 4 6 0.005 1 9 0.116
HCC aetiology (N) 0.239 0.768
 Hepatitis C virus 17 11 6 4 13
 Hepatitis B virus 2 0 1 1 1
 Non-alcoholic fatty liver disease 11 9 2 2 9
 Alcohol abuse 3 3 0 1 2
 Primary biliary cholangitis 4 4 0 2 2
 Cryptogenic 1 0 1 0 1
Alpha fetoprotein (kU/L) 11 (0–30,335) 8.5 (0–30,335) 30 (1–23,106) 0.154 12 (4–2,345) 10 (0–30,335) 0.496
Albumin (g/L)* 36.39 ± 4.33 36.38 ± 4.68 36.44 ± 3.21 0.969 34 ± 3.2 37.25 ± 4.41 0.040
Serum creatinine (μmol/L) 70 (48–129) 72.5 (48–129) 70 (48–127) 0.757 59 (48–129) 76 (48–127) 0.037
Total bilirubin (μmol/L) 10 (6–24) 11.5 (7–24) 8 (6–14) 0.027 11 (7–24) 10 (6–20) 0.198
INR 1.09 (0.87–1.89) 1.1 (0.96–1.89) 1.07 (0.87–1.25) 0.302 1.09 (0.96–1.34) 1.07 (0.87–1.89) 0.842
Serum sodium (mmol/L) 139 (123–143) 139 (123–143) 139 (137–140) 0.519 139 (136–141) 138.5 (123–143) 0.590
Platelet count (×103/mm3)* 179.16 ± 61.57 165 ± 58.95 224.78 ± 47.98 0.009 141.3 ± 54.25 192.68 ± 59.11 0.021
ECOG performance status (N) 0.297 0.610
 0 30 21 9 8 22
 1 5 5 0 2 3
 Not applicable 3 3 0 0 3
Child-Pugh class (N) 1.000 0.462
 A 36 27 9 9 27
 B 2 2 0 1 1
BCLC stage (N) 0.472 0.575
 0 2 2 0 1 1
 A 31 22 9 8 23
 B 2 2 0 1 1
 Not applicable 3 3 0 0 3
MELD score 7 (6–24) 8 (6–24) 7 (6–11) 0.471 7 (6–10) 6 (6–24) 0.351
Wedged hepatic venous pressure (mmHg) 17.25 (7.5–35) 17 (8–34.5) 18 (7.5–35) 0.948 22.67 (14.5–23.67) 17 (7.5–35) 0.068
Free hepatic venous pressure (mmHg) 10.84 (3–27.33) 10.67 (3–26.67) 11.5 (6.5–27.33) 0.429 9.5 (3–13.5) 11 (4–27.33) 0.507
HVPG (mmHg) 6 (0–14) 6 (2–14) 5 (0–11) 0.110 11.17 (10.17–14) 5 (0–9) <0.001
HVPG 5–9 mmHg (N) 17 13 4 1.000 0 17 <0.001
HVPG ≥10 mmHg (N) 10 9 1 0.396 10 0 <0.001
Inferior vena cava pressure (mmHg) 10 (2–28) 10 (2–24) 10 (5–28) 0.739 8 (3–13) 10 (2–28) 0.578
Right atrial pressure (mmHg) 6.5 (−3–23) 6 (−3–23) 7 (0–22) 0.420 4 (−1–9) 7 (−3–23) 0.369
Diabetes mellitus (N) 8 6 2 1.000 0 8 0.082
Arterial hypertension (N) 16 11 5 0.450 2 14 0.143
COPD (N) 2 2 0 1.000 0 2 1.000
Cirrhosis (N) <0.001 0.396
 Compensated 28 28 0 8 20
 Decompensated (only grade 1 ascites) 1 1 0 1 0
Pathological grading background liver (N) <0.001 0.497
 Healthy 3 0 3 0 3
 Bridging fibrosis 5 0 5 1 4
 Moderate fibrosis 1 0 1 0 1
 Established cirrhosis 18 18 0 7 11
 Complete cirrhosis 11 11 0 2 9
Splenomegaly (N) 2 2 0 1.000 1 1 0.462
Gastroesophageal varices (N) 5 5 0 0.312 1 4 1.000
Ascites (N) 1.000 0.263
 Grade 1 1 1 0 1 0

Abbreviations: BCLC, Barcelona Clinic Liver Cancer; COPD, chronic obstructive pulmonary disease; ECOG, Eastern Cooperative Oncology Group; HCC, hepatocellular carcinoma; INR, international normalised ratio; HVPG, hepatic venous pressure gradient; MELD, model for end-stage liver disease; UICC, Union for International Cancer Control. *Normally distributed variable displayed with mean ± standard deviation.

Bold values indicate a P value < 0.05.

Post-resection complications were analysed for the time of hospitalisation or up to 90 days after resection. Analysed liver complications included liver dysfunction, new or worsening ascites, biliary leakage, hepatic encephalopathy, and post-hepatectomy haemorrhage. Liver dysfunction was defined by 50–50 criteria positive on two or more consecutive days after liver resection, i.e., a prothrombin time of <50% and a serum bilirubin level of >50 µmol/L, considering the blood count on the third, fifth, and seventh days after resection [22,23]. Post-hepatectomy haemorrhage was defined as bleeding requiring transfusion of packed red blood cells for a significant drop in haemoglobin, radiological intervention, or relook laparotomy [24].

Non-liver complications included acute kidney injury, mechanic ileus, pneumonia, type 1 respiratory failure, cardiovascular complications, or sepsis. Prolonged hospitalisation was considered if the hospital stay length exceeded the median of the overall cohort.

2.3 HVPG measurement

Potential candidates for HCC resection with clinical or imaging signs suggestive of cirrhosis were referred for HVPG measurement and, if applicable, simultaneous transjugular liver biopsy to assess the severity of advanced chronic liver disease and evaluate the feasibility and safety of liver resection. Measurements were performed by seven consultant interventional radiologists with 2–17 years of experience. Under aseptic technique and local anaesthesia, a 19-G needle was used to puncture the right internal jugular vein (left if the right side is not suitable) under ultrasound guidance. A 7 Fr Super Arrow-Flex® sheath (Teleflex Medical Europe Ltd, Athlon, Leinster, Ireland) was introduced using Seldinger technique, after which a 4 Fr Cobra Catheter (Cordis Corp., Miami Lakes, Florida, USA) was used to cannulate the right or middle hepatic veins. Measurements were performed either with:

  1. A 4 Fr Cobra catheter. The free hepatic venous pressure (FHVP) was measured while the catheter floated freely in the hepatic vein. The wedged hepatic venous pressure (WHVP) was obtained with the catheter wedged into the most distal aspect of the vein until no blood could be aspirated. A wedged venography was performed to confirm the position.

  2. An occlusion balloon catheter (Berenstein, Boston Scientific, Marlborough, Massachusetts, USA). The WHVP was obtained while the inflated balloon occluded the vein. The measured values were retrieved by connecting the catheter to a pressure transducer and monitor. A minimum of three readings were obtained for FHVP and WHVP, respectively. The HVPG was calculated by the difference between the mean WHVP and FHVP of all subsequent measurements. In addition, pressures in the right atrium and inferior vena cava were documented. Patients were monitored and required bed rest for 2 h after the procedure.

2.4 Statistical analysis

Statistical analysis was performed using SPSS Statistics 25 (IBM, Armonk, New York, USA). Categorical/nominal variables were reported as frequencies and continuous variables using mean and standard deviation if normally distributed or median and range for non-normally distributed values. Normal distribution was tested with the Shapiro–Wilk test. Univariable/multivariable backward Cox and binary logistic regression were performed to identify risk factors of poorer OS or TTR and 90-day post-resection complications or prolonged hospital stay, respectively. Variables with a P value of <0.1 in the univariable analysis were included in multivariable regression analysis to identify independent risk factors. Multicollinearity between variables was tested with Pearson's (if continuous variables) or Spearman's (if categorical/nominal data) correlation analysis (thresholds: ≥0.8/≤−0.8) [25]. Cut-off points were established with the area under receiver operating characteristic curve, choosing the value that maximises the sum of sensitivity and specificity. Kaplan–Meier analysis and log-rank test were used to compare OS and TTR between the determined thresholds and sub-cohorts. The mean survival times with 95% confidence intervals (CI) were reported for better comparability because the median could not be estimated in Kaplan–Meier analysis for all sub-cohorts due to the partially small number of events. Comparison of variables between patients with or without cirrhosis and patients with or without CSPH was performed using the chi-squared test, Fisher's exact test, Mann–Whitney U test, or Student's t-test, as appropriate. A two-sided asymptotic P value of <0.05 was considered significant.

3 Results

3.1 Study cohort

HPVG measurements for evaluation of HCC resection were performed in 66 patients between January 2014 and April 2022. Twenty-eight (42%) patients were deemed ineligible for resection due to CSPH (N = 17 (26%), with HVPG measurements of 12–24 mmHg), insufficient predicted residual liver volume (N = 5 (8%)), poor general health condition/HCC involvement of the portal vein (N = 2 (3%) each), or hilar lymph node metastases/no further treatment was desired (N = 1 (1%) each).

Ultimately, 38 (58%) patients were included for analysis. The median follow-up time was 34.5 (range: 2–81) months. Among the included patients, 10 (26%) patients died (seven (18%) due to HCC recurrence, 3 (8%) due to postoperative complications as below), and 23 (61%) patients developed disease progression during follow-up. The mean OS was 60.36 [95% CI, 49.96–70.76] months and mean TTR 29.4 [95% CI, 19.55–39.25] months. Liver cirrhosis was present in 29 (76%) patients at the time of resection, according to the pathologic reports of liver resection tissue. Three (8%) of the nine (24%) remaining patients had healthy liver background parenchyma, five (13%) bridging fibrosis, and one (3%) moderate fibrosis.

Size of largest lesion, macroscopic vascular invasion, and platelet count were significantly higher in patients with non-cirrhotic HCC, while the total bilirubin level was significantly higher in patients with cirrhosis at baseline. The mean OS for cirrhotic patients (62.27 [95% CI, 50.98–73.56] months) did not differ significantly compared to non-cirrhotic patients (39.4 [95% CI, 28.22–50.58] months; P = 0.439). The mean TTR was significantly higher in patients with cirrhosis (34.36 [95% CI, 22.69–46.04] months versus 12.42 [95% CI, 3.41–21.44] months in non-cirrhotic patients; P = 0.006). All baseline characteristics of each cohort are displayed in Table 1.

3.2 HVPG measurement and treatment characteristics

Table 2 displays all treatment characteristics and observed complications within 90 days after resection.

Table 2

Treatment characteristics observed 90-day complications, and postoperative outcome of the overall cohort and the comparison of patients with/without cirrhosis and patients with/without clinically significant portal hypertension (≥10 mmHg)

Variables Overall cohort (N = 38) Cirrhosis (N = 29) Non-cirrhotic (N = 9) P value comparison HVPG ≥10 mmHg (N = 10) HVPG <10 mmHg (N = 28) P value comparison
Pre-HVPG exam therapies (N) 0.576 0.773
 Radiofrequency ablation 1 1 0 0 1
 Liver resection 1 0 1 0 1
 Transarterial radioembolisation 5 4 1 2 3
Post-HVPG exam therapies (N) 0.507 0.036
 Resection 38 29 9 10 28
 Radiofrequency ablation 7 5 2 2 5
 Transarterial radioembolisation 11 8 3 4 7
 Re-resection 1 1 0 0
 Liver transplantation 3 3 0 2 1
 Atezolizumab and cabozantinib 1 1 0 1 0
 Atezolizumab and bevacizumab 1 1 0 0 1
 External beam radiotherapy 1 0 1 0 1
 Sorafenib 1 0 1 0 1
Resection characteristics (N)
 Open 38 29 9 1.000 10 28 1.000
 Anatomical 6 5 8 1.000 0 6 0.168
 Non-anatomical 32 24 1 10 22
 Major (>2 segments) 13 8 5 0.226 2 11 0.441
 Minor (1–2 segments) 25 21 4 8 17
 Lengths hospital stay (days) 9 (4–58) 9 (4–58) 7 (4–35) 0.469 8 (4–20) 9 (4–58) 0.527
Complications until 90 days after resection (N)
 90-day mortality 3 2 1 1.000 1 2 1.000
 Liver dysfunction 5 4 1 1.000 3 2 0.103
 Postoperative haemorrhage 4 3 1 1.000 1 3 1.000
 Sepsis 2 1 1 0.422 0 2 1.000
 New/worsening ascites 0.423 0.685
 Grade 1 3 2 1 1 2
 Grade 2 8 6 2 1 7
 Grade 3 1 0 1 0 1
 Hospital-acquired pneumonia 5 5 0 0.312 2 3 0.592
 Type 1 respiratory failure 2 2 0 1.000 0 2 1.000
 Acute kidney injury 7 6 1 1.000 3 4 0.351
 Mechanic ileus 3 3 0 1.000 0 3 0.552
 Portal vein thrombosis 1 1 0 1.000 0 1 1.000
 Hepatic encephalopathy 1 1 0 1.000 0 1 1.000
Follow-up time (months) 34.5 (2–81) 35 (2–81) 30 (3–51) 0.525 37.5 (11–69) 30 (2–81) 0.426
Disease recurrence (N) 23 16 7 0.006 9 14 0.048
 (First) intrahepatic 23 16 7 9 14
 1-year recurrence-free rate 68.9% 77.5% 40% 60% 72.1%
 3-year recurrence-free rate 27.9% 35.8% 0% 0% 42.2%
Death (N) 10 7 3 0.439 5 5 0.146
 1-year OS rate 92% 92.8% 88.9% 90% 92.9%
 3-year OS rate 73.6% 77.3% 62.2% 58.3% 82.1%

Abbreviations: HVPG, hepatic venous pressure gradient; OS, overall survival.

Bold values indicate a P value < 0.05.

HVPG measurements were performed with a balloon occlusion (N = 4 (11%)) or a Cobra catheter (N = 3 (8%)). However, in most patients (N = 31 (82%)), it could not be retrospectively determined which of the two catheters was used due to missing information in the interventional reports. The median HVPG was 6 (range: 0–14) mmHg in the overall cohort. Ten (26%) patients had CSPH and 28 (74%) patients HVPG levels <10 mmHg. Patients with CSPH had a significantly lower median lesion size (16 (range: 9.5–34.67) mm versus 32.75 (range: 11–110) mm in non-CSPH patients; P = 0.029), serum creatinine levels (59 (range: 48–129) μmol/L versus 76 (range: 48–127) μmol/L; P = 0.037), average platelet count (141.3 ± 54.25 ×103/mm3 versus 192.68 ± 59.11×103/mm3 in non-CSPH patients, P = 0.021), and serum albumin levels (34 ± 3.2 g/L versus 37.25 ± 4.41 g/L in non-CSPH patients; P = 0.040) at the time of HVPG measurement (Table 1). Post-resection treatments also differed significantly between both groups (see Table 2). Nine (24%) of the ten (26%) patients with CSPH had cirrhosis and one (3%) bridging fibrosis at resection. The measured HVPG in cirrhotic patients was not significantly higher compared to non-cirrhotic patients (6 (range: 2–14) mmHg versus 5 (range: 0–11) mmHg; P = 0.110).

Three (8%) patients died within 90 days post-resection after a median time of 35 (range: 20–45) days. Two (5%) patients with HPVG values <5 mmHg died of postoperative pneumonia-associated complications. The third (3%) patient with an HPVG of 14 mmHg died of cardiovascular complications after acute kidney failure and acute coronary syndrome. Liver dysfunction was noted in all three patients who died within 90 days after surgery and in five patients (13%) in total (median HVPG: 11.17, range: 0–13.5 mmHg). Any recorded post-resection complication or the length of hospital admission did not differ between patients with and without cirrhosis or patients with and without CSPH (see Table 2).

3.3 Independent risk factors for reduced 90-day survival, OS, and TTR

Cox regression results for 90-day survival, OS, and TTR are shown in Table 3.

Table 3

Results of univariable and multivariable Cox regression analysis for 90-day survival, overall survival, and time to recurrence in the overall cohort and patients with or without cirrhosis

Variables Univariable Cox regression HR (95% CI) P value Multivariable Cox regression HR (95% CI) P value
90-day survival in the overall cohort ( N = 38)
No variables with P < 0.1
Overall survival in the overall cohort ( N = 38)
Age 1.08 (0.99–1.12) 0.075
Time to recurrence in the overall cohort ( N = 38)
HVPG 1.16 (1.02–1.32) 0.026 1.26 (1.09–1.46) 0.002
Serum creatinine 1.03 (1.00–1.05) 0.071 1.04 (1.02–1.07) 0.002
Size of largest lesion 1.02 (0.99–1.04) 0.063 1.03 (1.01–1.05) 0.004
90-day survival in patients with cirrhosis ( N = 29)
No variables with P < 0.1
Overall survival in patients with cirrhosis ( N = 29)
HVPG 1.28 (1.01–1.61) 0.041 1.28 (1.01–1.61) 0.041
Total bilirubin 1.14 (0.98–1.33) 0.097
Time to recurrence in patients with cirrhosis ( N = 29)
HVPG 1.26 (1.07–1.50) 0.007 1.46 (1.14–1.86) 0.002
Serum creatinine 1.05 (1.01–1.10) 0.009 1.08 (1.03–1.14) 0.004
ECOG status 3.01 (0.87–10.42) 0.082 4.16 (1.00–17.28) 0.049
Child-Pugh score 2.00 (1.11–3.60) 0.020
90-day survival in non-cirrhotic patients ( N = 9)
No variables with P < 0.1
Overall survival in non-cirrhotic patients ( N = 9)
No variables with P < 0.1
Time to recurrence in non-cirrhotic patients ( N = 9)
No variables with P < 0.1

Abbreviations: CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; HR, hazard ratio; HVPG, hepatic venous pressure gradient.

Bold values indicate a P value < 0.05.

In the overall cohort, the preoperative HVPG level was a significant independent risk factor for poorer TTR (hazard ratio [HR], 1.26 [95% CI, 1.09–1.46]; P = 0.002), but not for OS. ROC analysis revealed a HVPG cut-off value of 7.5 mmHg (area under curve [AUC], 0.76 [95% CI, 0.60–0.92]; P = 0.007) for reduced TTR (Kaplan–Meier analysis: ≥7.5 mmHg: 17.18 [95% CI, 10.42–23.94] months versus <7.5 mmHg: 43.81 [95% CI, 27.11–60.5] months; P = 0.009; see Figure 1). Additional independent risk factors for reduced TTR in the overall cohort were serum creatinine (HR, 1.04 [95% CI, 1.02–1.07]; P = 0.002) and size of largest lesion (HR, 1.03 [95% CI, 1.01–1.05]; P = 0.004). However, no significant cut-offs were found in ROC analysis (serum creatinine: AUC, 0.46 [95% CI, 0.27–0.65]; P = 0.664; size of largest lesion: AUC, 0.57 [95% CI, 0.38–0.76]; P = 0.503). There were no significant independent risk factors for 90-day survival or OS in the overall cohort.

Figure 1 Kaplan–Meier curves for the determined significant cut-off values for time to recurrence in the overall cohort (a) or overall survival (b) and time to recurrence (c) in patients with cirrhosis after liver resection.
Figure 1

Kaplan–Meier curves for the determined significant cut-off values for time to recurrence in the overall cohort (a) or overall survival (b) and time to recurrence (c) in patients with cirrhosis after liver resection.

Subgroup analysis in patients with cirrhosis showed HVPG to be an independent risk factor for poorer OS (HR, 1.28 [95% CI, 1.01–1.61]; P = 0.041) and TTR (HR, 1.46 [95% CI, 1.14–1.86]; P = 0.002). Cut-off values of 8.5 mmHg (AUC, 0.80 [95% CI, 0.56–1.05]; P = 0.015) for poorer OS and 7.5 mmHg (AUC, 0.80 [95% CI, 0.63–0.98]); P = 0.001) for TTR were identified in ROC analysis. For the determined cut-offs, Kaplan–Meier analysis (Figure 1) demonstrated a significantly reduced OS (≥8.5 mmHg: 44.39 [95% CI, 32.27–56.50] months); <8.5 mmHg (76.84 [95% CI, 68.91–84.77] months; P = 0.012) and TTR (≥7.5 mmHg: 20.4 [95% CI, 13.01–27.78] months; <7.5 mmHg: 54.05 [95% CI, 35.9–72.19] months; P = 0.007). Serum creatinine and ECOG status at baseline were independent risk factors for reduced TTR in Cox regression for cirrhotic patients, although ROC analysis displayed no significant cut-off values (serum creatinine: AUC, 0.48 [95% CI, 0.26–0.7]; P = 0.844; ECOG status: AUC, 0.58 [95% CI, 0.35–0.8]; P = 0.513).

In non-cirrhotic patients, no risk factors for OS, TTR, or 90-day survival were demonstrated.

3.4 Independent risk factors for postoperative complications and prolonged hospital stay

The logistic regression results for 90-day post-resection complications and prolonged hospital stay are summarised in Table 4. The HVPG level was not associated with post-resection complications in the overall cohort or sub-cohorts. The only significant independent risk factor was total bilirubin at baseline for acute kidney injury in the overall cohort (odds ratio (OR), 1.37 [95% CI, 1.02–1.83]; P = 0.036). Patient age was the only other significant parameter in univariable analysis predicting new/worsening ascites (OR, 1.16 [95% CI, 1.02–1.31]; P = 0.028). Cut-off values in ROC analysis were a total bilirubin level of 15.5 μmol/L for predicting acute kidney injury (AUC, 0.77 [95% CI, 0.57–0.97]; P = 0.007) and a patient age of 62 years (AUC, 0.71 [95% CI, 0.55–0.87]; P = 0.011) for new/worsening ascites after resection. In the sub-cohort analysis, no significant independent risk factors for post-resection complications were found.

Table 4

Results of univariable and multivariable logistic regression analysis for 90-day post-resection complications and prolonged hospital stay in the overall cohort and patients with or without cirrhosis

Complications Variables Univariable logistic regression OR (95% CI) P value Multivariable logistic regression OR (95% CI) P value
Overall cohort ( N = 38)
Prolonged hospital stay
ECOG status 9.33 (0.91–95.57) 0.060 10.5 (1.01–108.76) 0.049
UICC stage 2.62 (1.08–6.37) 0.034
Liver dysfunction
Total bilirubin 1.24 (0.99–1.55) 0.063
New/worsening ascites
Age 1.16 (1.02–1.31) 0.028
Hospital-acquired pneumonia
Total bilirubin 1.21 (0.97–1.50) 0.091
Acute kidney injury
Total bilirubin 1.27 (1.02–1.59) 0.031 1.37 (1.02–1.83) 0.036
MELD score 1.29 (0.96–1.74) 0.098
Patients with cirrhosis ( N = 29)
Prolonged hospital stay
ECOG status 12.8 (1.15–142.58) 0.038 16 (1.38–185.41) 0.027
UICC stage 8.42 (1.18–60.14) 0.034
Liver dysfunction
Total bilirubin 1.28 (0.98–1.67) 0.076
New/worsening ascites
Number of lesions 3.26 (0.82–12.92) 0.093
Age 1.15 (0.99–1.34) 0.071
Average lesion size 1.06 (1.00–1.13) 0.051
Acute kidney injury
Total bilirubin 1.29 (1.00–1.65) 0.050
Non-cirrhotic patients ( N = 9)
No variables with P < 0.1 for any complication

Abbreviations: CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; MELD, model for end-stage liver disease; OR, odds ratio; UICC, Union for International Cancer Control.

Bold values indicate a P value < 0.05.

The median hospital stay length in the overall cohort was nine (range: 4–58) days. The ECOG status was an independent risk for a prolonged hospital stay in the overall cohort (OR, 10.5 [95% CI, 1.01–108.76]; P = 0.049) and in patients with cirrhosis (OR, 16 [95% CI, 1.38–185.41]; P = 0.027).

4 Discussion

In this study, the preoperative HVPG level was a significant independent risk factor for reduced TTR but not OS when considering all HCC patients who received liver resection with curative intent. In the subgroup analysis of patients with cirrhosis, the HVPG was also an independent risk factor for poorer OS. Cut-off values for reduced TTR were 7.5 mmHg in the overall cohort and 8.5 mmHg for poorer OS in cirrhotic patients. When considering only non-cirrhotic patients, HVPG was no risk factor in survival analysis. Furthermore, the HVPG level was no risk factor for 90-day survival, post-resection complications or prolonged hospital stay in any cohort.

Several studies have investigated the impact of preoperative HVPG values on postoperative complications in cirrhotic HCC patients. The reported 90-day mortality after HCC resection in patients with HVPG values of ≥10 mmHg ranges from 0 to 28%, which is in line with the 10% of patients (one out of ten) with an initial HVPG ≥10 mmHg in our study [13,14,17,26,27,28,29]. While some authors found significant differences in 90-day mortality between patients with and without CSPH [17], the majority did not [14,26,27,28,29], including our study. However, it is difficult to compare these results in detail due to differences in baseline characteristics, resection techniques, and study designs. The association of HVPG levels with postoperative ascites, haemorrhage, encephalopathy, or prolonged hospitalisation is also variable in the literature, with cut-off values ranging from >5 to ≥10 mmHg and varying significant findings [13,14,17,26,27,30]. We could not identify the HVPG level as an independent risk factor for any observed postoperative complication in patients with or without cirrhosis and found no differences between patients with and without CSPH. Some studies additionally reported that HVPG values of ≥10 mmHg are associated with postoperative liver dysfunction, decompensation in patients with cirrhosis, or prolonged hospitalisation, which was not the case in our study [13,14,17,26,28,29]. This might result from the small number of patients with CSPH and cirrhosis (N = 9 (24%)) in our cohort and, therefore, a low incidence of complications.

Several studies have examined the impact of HVPG measurements on long-term outcomes after HCC resection. Azoulay et al. found 1-/3-year OS rates of 89%/73% and 1-/3-year recurrence-free survival rates of 82%/62% in 79 cirrhotic HCC patients who underwent resection with HVPG values ≥10 mmHg [13]. These results were more favourable compared to our patients with CSPH (1-/3-year OS rates: 90%/58.3%; 1-/3-year recurrence-free rates: 60%/0%). While median MELD scores (8 versus 7 in our study) and Child-Pugh scores (N = 78 (99%) versus N = 36 (95%) with Child-Pugh A in our study) were comparable, significantly more patients with microvascular (N = 25 (32%) versus N = 27 (71%) in our study) and macrovascular tumour invasion (N = 3 (4%) versus N = 10 (26%) in our study) at time of resection might have led to a worse overall outcome in our analysis.

Llovet et al. found a significantly lower median OS in 43 cirrhotic patients with CSPH undergoing HCC resection after HVPG measurement, with 69 months in patients with an HVPG ≥10 mmHg versus 80 months in patients with <10 mmHg [31]. These results are comparable to the cut-off value of 8.5 mmHg found in our study to predict a worse OS in cirrhotic patients (≥8.5 mmHg: 44.39 months; <8.5 mmHg: 76.84 months). In contrast, other authors reported no significant associations between the HVPG and OS. Cucchetti et al. analysed 70 HCC patients with and without cirrhosis after HCC resection and found non-significant differences in 1-/3-year OS rates with 100%/100% in patients with a baseline HVPG <10 mmHg and 97.1%/79.4% in patients with HVPG levels ≥10 mmHg [14]. A possible explanation could be the combined analysis of patients with (N = 46 (66%)) and without cirrhosis (N = 24 (34%)) without comparing the subgroups. While patients with CSPH (of which nine (90%) out of ten patients had cirrhosis) in our cohort had lower averaged 1-/3-year OS rates of 90%/58.3%, patients without CSPH at baseline had comparable OS rates of 92.9%/82.1%. However, a detailed comparison of the cohort characteristics is not possible due to imbalances in sample size and the lack of pathological information provided.

Furthermore, Silva et al. showed that the HVPG level was no risk factor for poorer OS in univariable or multivariable analysis of 22 Child-Pugh A cirrhosis patients with resected HCC of a single nodule up to 5 cm [32]. In contrast, our study found a significant impact of HVPG on OS in cirrhotic patients, of which 27 (93%) had a Child-Pugh A score, although resection was performed in the presence of up to four lesions and a tumour size of up to 110 mm. Other results favouring the HCC resection in Child-Pugh A patients despite CSPH were described by Cortese and Tellado analysing 42 matched HCC patients with Child-Pugh A cirrhosis undergoing hepatic resection with or without CSPH, respectively, reporting no significant differences in 1-/3-year OS rates (CSPH: 85.7%/64.0%; non-CSPH: 92.9%/70.1%; P = 0.604) or disease-free survival rates (CSPH: 61.3%/44.4%; non-CSPH: 59.5%/29.5%; P = 0.296) [29]. Although 1-/3-year OS rates (CSPH: 90%/58.3%; non-CSPH: 92.9%/82.1%; P = 0.146) were comparable in our study, 1-/3-year recurrence-free rates (CSPH: 60%/0%; non-CSPH: 72.1%/42.2%; P = 0.048) were significantly reduced in patients with CSPH. Given that the patient characteristics between our studies – although again limited comparable – do not considerably differ, the analysis of a smaller cohort of ten (26%) CSPH patients may have resulted in sample bias, contributing to the fact that no CSPH patient remained disease-free after three years post-surgery in our study.

In summary, varying associations between pre-resection HVPG levels and long-term outcomes are reported in the literature, making it difficult to recommend pre-resection HVPG measurement in patients with HCC per se. However, in HCC patients with suspected liver cirrhosis or patients who are borderline surgical candidates, HVPG measurement could be performed simultaneously with a transjugular liver biopsy as an additional marker of disease extent to assist in the decision for or against liver resection. Moreover, combining HVPG measurement with liver biopsy could be particularly useful, as our study intends that abnormal HVPG values should not be considered as an absolute contraindication for liver resection, and a comprehensive assessment of other risk factors such as underlying cirrhosis is essential for an adequate evaluation of potential surgical candidates. Larger, prospective studies are needed to further validate the benefit of HVPG measurement before liver resection.

4.1 Limitations

Our study has limitations. The relatively small sample size might have led to sample bias, especially in the smaller non-cirrhotic or CSPH group. Transplantation remains the preferred option for cirrhotic patients within the criteria. Moreover, our current practice favours ablative therapies over liver resection for borderline surgical candidates. Since we only perform HVPG measurements when liver cirrhosis is suspected clinically or by imaging, and the majority were subsequently classified as cirrhotic, thus ultimately limiting the statistical power of our analysis. Due to the retrospective nature of this study, we could not assess for missing information in the medical reports. Therefore, we could not identify the specific catheters used in 31 out of 38 patients and were unable to compare HVPG levels and outcomes between patients with balloon occlusion and conventional catheter measurements. However, both techniques have been recognised in the literature, were performed with at least three repeated measurements, and were assessed in combination with the inferior vena cava and right atrial pressures as internal reference [33,34]. Notably, we have adopted the use of balloon occlusion catheters only to standardise the HVPG measurement at our centre since the completion of this study, which is now also the recommended approach in the most recently published Baveno VII Consensus Workshop to reduce random errors in WHVP measurement [35]. Finally, it should be noted that the FHVP level is affected by the catheter tip position and vein morphology, which may result in varying results, especially among different operators [36]. However, all investigators in our centre followed the same standard operating procedure.

5 Conclusions

Our results indicate that the preoperative HVPG level in cirrhotic patients with HCC undergoing liver resection has a significant clinical impact on the long-term outcome with poorer OS and TTR from HVPG levels of 8.5 and 7.5 mmHg, respectively, while the occurrence of postoperative complications appears to be independent of the HVPG.

Acknowledgments

We would like to thank Dr Keno K. Bressem for his earlier efforts in creating the Kaplan–Meier survival curves. We would also like to thank the Interventional Radiology Team (Drs Andrew Winterbottom, Nadeem Shaida, Nicholas Hilliard, Amir Helmy, Sharmini Desigan, and Simon Hilliard), the Hepatocellular Carcinoma Multidisciplinary Team, the Hepatology Team, and the Liver Resection Team for their clinical involvement in this cohort of patients.

  1. Funding information: We acknowledge financial support for open access publication of this manuscript from the Open Access Publication Fund of Charité – Universitätsmedizin Berlin and the German Research Foundation (DFG). TCS received funding from Cancer Research UK, Cambridge Centre Advanced Cancer Imaging Programme. The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation.

  2. Author contributions: FB: study design, data analysis, writing and revision of the article. KNDP: study design, writing and revision of the article. PG: study design and revision of the article. MA: study design and revision of the article. MH: study design and revision of the article. TCS: study design, data analysis, writing and revision of the article.

  3. Conflict of interest: Authors state no conflict of interest.

  4. Data availability statement: Research data will be shared upon reasonable request and in accordance with the local data protection guidelines by the corresponding author.

References

[1] D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44(1):217–31. 10.1016/j.jhep.2005.10.013.Search in Google Scholar PubMed

[2] Groszmann RJ, Bosch J, Grace ND, Conn HO, Garcia-Tsao G, Navasa M, et al. Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology. 1990;99(5):1401–7. 10.1016/0016-5085(90)91168-6.Search in Google Scholar PubMed

[3] Groszmann R, Vorobioff JD, Gao H. Measurement of portal pressure: when, how, and why to do it. Clin Liver Dis. 2006;10(3):499–512, viii. 10.1016/j.cld.2006.08.005.Search in Google Scholar PubMed

[4] Bosch J, Abraldes JG, Berzigotti A, García-Pagan JC. The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol. 2009;6(10):573–82. 10.1038/nrgastro.2009.149.Search in Google Scholar PubMed

[5] Blasco A, Forns X, Carrión JA, García-Pagán JC, Gilabert R, Rimola A, et al. Hepatic venous pressure gradient identifies patients at risk of severe hepatitis C recurrence after liver transplantation. Hepatology. 2006;43(3):492–9. 10.1002/hep.21090.Search in Google Scholar PubMed

[6] de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C, Abraldes JG, et al. Baveno VII – Renewing consensus in portal hypertension. J Hepatology. 2022;76(4):959–74. 10.1016/j.jhep.2021.12.022.Search in Google Scholar PubMed

[7] Ripoll C, Groszmann RJ, Garcia-Tsao G, Bosch J, Grace N, Burroughs A, et al. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol. 2009;50(5):923–8. 10.1016/j.jhep.2009.01.014.Search in Google Scholar PubMed PubMed Central

[8] Ripoll C, Groszmann R, Garcia-Tsao G, Grace N, Burroughs A, Planas R, et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. 2007;133(2):481–8. 10.1053/j.gastro.2007.05.024.Search in Google Scholar PubMed

[9] Procopet B, Berzigotti A. Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy. Gastroenterol Rep (Oxf). 2017;5(2):79–89. 10.1093/gastro/gox012.Search in Google Scholar PubMed PubMed Central

[10] Berzigotti A, Reig M, Abraldes JG, Bosch J, Bruix J. Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis. Hepatology. 2015;61(2):526–36. 10.1002/hep.27431.Search in Google Scholar PubMed

[11] Cucchetti A, Cescon M, Pinna AD. Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: A systematic review and meta-analysis. More Doubt Clarity Hepatol. 2015;62(3):976–7. 10.1002/hep.27702.Search in Google Scholar PubMed

[12] Cucchetti A, Ercolani G, Vivarelli M, Cescon M, Ravaioli M, Ramacciato G, et al. Is portal hypertension a contraindication to hepatic resection? Ann Surg. 2009;250(6):922–8. 10.1097/SLA.0b013e3181b977a5.Search in Google Scholar PubMed

[13] Azoulay D, Ramos E, Casellas-Robert M, Salloum C, Lladó L, Nadler R, et al. Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension. JHEP Rep. 2021;3(1):100190. 10.1016/j.jhepr.2020.100190.Search in Google Scholar PubMed PubMed Central

[14] Cucchetti A, Cescon M, Golfieri R, Piscaglia F, Renzulli M, Neri F, et al. Hepatic venous pressure gradient in the preoperative assessment of patients with resectable hepatocellular carcinoma. J Hepatol. 2016;64(1):79–86. 10.1016/j.jhep.2015.08.025.Search in Google Scholar PubMed

[15] Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67(1):358–80. 10.1002/hep.29086.Search in Google Scholar PubMed

[16] European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236. 10.1016/j.jhep.2018.03.019.Search in Google Scholar PubMed

[17] Boleslawski E, Petrovai G, Truant S, Dharancy S, Duhamel A, Salleron J, et al. Hepatic venous pressure gradient in the assessment of portal hypertension before liver resection in patients with cirrhosis. Br J Surg. 2012;99(6):855–63. 10.1002/bjs.8753.Search in Google Scholar PubMed

[18] American College of Radiology (ACR). CT/MRI Liver Imaging Reporting and Data System. [Internet]. 2018 [cited 2023 Jan 5]. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS/LI-RADS-CT-MRI--v2018.Search in Google Scholar

[19] Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology. 2003;38(1):258–66. 10.1053/jhep.2003.50315.Search in Google Scholar PubMed

[20] Bezerra AS, D'Ippolito G, Faintuch S, Szejnfeld J, Ahmed M. Determination of splenomegaly by CT: Is there a place for a single measurement? Am J Roentgenology. 2005;184(5):1510–3. 10.2214/ajr.184.5.01841510.Search in Google Scholar PubMed

[21] Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg. 1982;6(1):3–9. 10.1007/BF01656368.Search in Google Scholar PubMed

[22] Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, et al. The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 2005;242(6):824–8; discussion 8-9. 10.1097/01.sla.0000189131.90876.9e.Search in Google Scholar PubMed PubMed Central

[23] Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg. 2003;138(11):1198–206; discussion 206. 10.1001/archsurg.138.11.1198.Search in Google Scholar PubMed

[24] Rahbari NN, Garden OJ, Padbury R, Maddern G, Koch M, Hugh TJ, et al. Post-hepatectomy haemorrhage: A definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxf). 2011;13(8):528–35. 10.1111/j.1477-2574.2011.00319.x.Search in Google Scholar PubMed PubMed Central

[25] Chan YH. Biostatistics 104: Correlational analysis. Singap Med J. 2003;44(12):614–9.Search in Google Scholar

[26] Casellas-Robert M, Lim C, Lopez-Ben S, Lladó L, Salloum C, Codina-Font J, et al. Laparoscopic liver resection for hepatocellular carcinoma in child-pugh A patients with and without portal hypertension: A multicentre study. World J Surg. 2020;44(11):3915–22. 10.1007/s00268-020-05687-9.Search in Google Scholar PubMed

[27] Molina V, Sampson-Dávila J, Ferrer J, Fondevila C, Díaz del Gobbo R, Calatayud D, et al. Benefits of laparoscopic liver resection in patients with hepatocellular carcinoma and portal hypertension: a case-matched study. Surg Endoscopy. 2018;32(5):2345–54. 10.1007/s00464-017-5930-1.Search in Google Scholar PubMed

[28] Lim C, Osseis M, Lahat E, Doussot A, Sotirov D, Hemery F, et al. Safety of laparoscopic hepatectomy in patients with hepatocellular carcinoma and portal hypertension: interim analysis of an open prospective study. Surg Endoscopy. 2019;33(3):811–20. 10.1007/s00464-018-6347-1.Search in Google Scholar PubMed

[29] Cortese S, Tellado JM. Impact and outcomes of liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension. Cir Cir. 2022;90(5):579–87. 10.24875/ciru.22000041.Search in Google Scholar

[30] Stremitzer S, Tamandl D, Kaczirek K, Maresch J, Abbasov B, Payer BA, et al. Value of hepatic venous pressure gradient measurement before liver resection for hepatocellular carcinoma. Br J Surg. 2011;98(12):1752–8. 10.1002/bjs.7672.Search in Google Scholar PubMed

[31] Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology. 1999;30(6):1434–40. 10.1002/hep.510300629.Search in Google Scholar PubMed

[32] Silva MF, Sapisochin G, Strasser SI, Hewa-Geeganage S, Chen J, Wigg AJ, et al. Liver resection and transplantation offer similar 5-year survival for Child-Pugh-Turcotte A HCC-patients with a single nodule up to 5 cm: a multicenter, exploratory analysis. Eur J Surg Oncol. 2013;39(4):386–95. 10.1016/j.ejso.2012.12.011.Search in Google Scholar PubMed

[33] Chelliah ST, Keshava SN, Moses V, Surendrababu NRS, Zachariah U, Eapen CE. Measurement of hepatic venous pressure gradient revisited: Catheter wedge vs balloon wedge techniques. Indian J Radiol Imaging. 2011;21:291–3.10.4103/0971-3026.90693Search in Google Scholar PubMed PubMed Central

[34] Bochnakova T. Hepatic venous pressure gradient. Clin Liver Dis (Hoboken). 2021;17(3):144–8. 10.1002/cld.1031.Search in Google Scholar PubMed PubMed Central

[35] Ferral H, Garcia-Pagàn JC, Schepis F, Gaba RC, Zanetto A, Perez-Campuzano V, et al. HVPG as a gold standard: Consensus statements of panel 1. In: Portal hypertension VII [Internet]. Vol. 1. Cham: Springer International Publishing; 2022. p. 61–4. 10.1007/978-3-031-08552-9_6.Search in Google Scholar

[36] Rössle M, Blanke P, Fritz B, Schultheiss M, Bettinger D. Free hepatic vein pressure is not useful to calculate the portal pressure gradient in cirrhosis: A morphologic and hemodynamic study. J Vasc Interventional Radiol. 2016;27(8):1130–7. 10.1016/j.jvir.2016.03.028.Search in Google Scholar PubMed

Received: 2023-02-23
Revised: 2023-05-03
Accepted: 2023-10-27
Published Online: 2024-03-08

© 2024 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

  1. Research Articles
  2. EDNRB inhibits the growth and migration of prostate cancer cells by activating the cGMP-PKG pathway
  3. STK11 (LKB1) mutation suppresses ferroptosis in lung adenocarcinoma by facilitating monounsaturated fatty acid synthesis
  4. Association of SOX6 gene polymorphisms with Kashin-Beck disease risk in the Chinese Han population
  5. The pyroptosis-related signature predicts prognosis and influences the tumor immune microenvironment in dedifferentiated liposarcoma
  6. METTL3 attenuates ferroptosis sensitivity in lung cancer via modulating TFRC
  7. Identification and validation of molecular subtypes and prognostic signature for stage I and stage II gastric cancer based on neutrophil extracellular traps
  8. Novel lumbar plexus block versus femoral nerve block for analgesia and motor recovery after total knee arthroplasty
  9. Correlation between ABCB1 and OLIG2 polymorphisms and the severity and prognosis of patients with cerebral infarction
  10. Study on the radiotherapy effect and serum neutral granulocyte lymphocyte ratio and inflammatory factor expression of nasopharyngeal carcinoma
  11. Transcriptome analysis of effects of Tecrl deficiency on cardiometabolic and calcium regulation in cardiac tissue
  12. Aflatoxin B1 induces infertility, fetal deformities, and potential therapies
  13. Serum levels of HMW adiponectin and its receptors are associated with cytokine levels and clinical characteristics in chronic obstructive pulmonary disease
  14. METTL3-mediated methylation of CYP2C19 mRNA may aggravate clopidogrel resistance in ischemic stroke patients
  15. Understand how machine learning impact lung cancer research from 2010 to 2021: A bibliometric analysis
  16. Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay
  17. Metformin plus L-carnitine enhances brown/beige adipose tissue activity via Nrf2/HO-1 signaling to reduce lipid accumulation and inflammation in murine obesity
  18. Downregulation of carbonic anhydrase IX expression in mouse xenograft nasopharyngeal carcinoma model via doxorubicin nanobubble combined with ultrasound
  19. Feasibility of 3-dimensional printed models in simulated training and teaching of transcatheter aortic valve replacement
  20. miR-335-3p improves type II diabetes mellitus by IGF-1 regulating macrophage polarization
  21. The analyses of human MCPH1 DNA repair machinery and genetic variations
  22. Activation of Piezo1 increases the sensitivity of breast cancer to hyperthermia therapy
  23. Comprehensive analysis based on the disulfidptosis-related genes identifies hub genes and immune infiltration for pancreatic adenocarcinoma
  24. Changes of serum CA125 and PGE2 before and after high-intensity focused ultrasound combined with GnRH-a in treatment of patients with adenomyosis
  25. The clinical value of the hepatic venous pressure gradient in patients undergoing hepatic resection for hepatocellular carcinoma with or without liver cirrhosis
  26. Development and validation of a novel model to predict pulmonary embolism in cardiology suspected patients: A 10-year retrospective analysis
  27. Downregulation of lncRNA XLOC_032768 in diabetic patients predicts the occurrence of diabetic nephropathy
  28. Circ_0051428 targeting miR-885-3p/MMP2 axis enhances the malignancy of cervical cancer
  29. Effectiveness of ginkgo diterpene lactone meglumine on cognitive function in patients with acute ischemic stroke
  30. The construction of a novel prognostic prediction model for glioma based on GWAS-identified prognostic-related risk loci
  31. Evaluating the impact of childhood BMI on the risk of coronavirus disease 2019: A Mendelian randomization study
  32. Lactate dehydrogenase to albumin ratio is associated with in-hospital mortality in patients with acute heart failure: Data from the MIMIC-III database
  33. CD36-mediated podocyte lipotoxicity promotes foot process effacement
  34. Efficacy of etonogestrel subcutaneous implants versus the levonorgestrel-releasing intrauterine system in the conservative treatment of adenomyosis
  35. FLRT2 mediates chondrogenesis of nasal septal cartilage and mandibular condyle cartilage
  36. Challenges in treating primary immune thrombocytopenia patients undergoing COVID-19 vaccination: A retrospective study
  37. Let-7 family regulates HaCaT cell proliferation and apoptosis via the ΔNp63/PI3K/AKT pathway
  38. Phospholipid transfer protein ameliorates sepsis-induced cardiac dysfunction through NLRP3 inflammasome inhibition
  39. Postoperative cognitive dysfunction in elderly patients with colorectal cancer: A randomized controlled study comparing goal-directed and conventional fluid therapy
  40. Long-pulsed ultrasound-mediated microbubble thrombolysis in a rat model of microvascular obstruction
  41. High SEC61A1 expression predicts poor outcome of acute myeloid leukemia
  42. Comparison of polymerase chain reaction and next-generation sequencing with conventional urine culture for the diagnosis of urinary tract infections: A meta-analysis
  43. Secreted frizzled-related protein 5 protects against renal fibrosis by inhibiting Wnt/β-catenin pathway
  44. Pan-cancer and single-cell analysis of actin cytoskeleton genes related to disulfidptosis
  45. Overexpression of miR-532-5p restrains oxidative stress response of chondrocytes in nontraumatic osteonecrosis of the femoral head by inhibiting ABL1
  46. Autologous liver transplantation for unresectable hepatobiliary malignancies in enhanced recovery after surgery model
  47. Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section
  48. Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study
  49. No genetic causality between obesity and benign paroxysmal vertigo: A two-sample Mendelian randomization study
  50. Identification and validation of autophagy-related genes in SSc
  51. Long non-coding RNA SRA1 suppresses radiotherapy resistance in esophageal squamous cell carcinoma by modulating glycolytic reprogramming
  52. Evaluation of quality of life in patients with schizophrenia: An inpatient social welfare institution-based cross-sectional study
  53. The possible role of oxidative stress marker glutathione in the assessment of cognitive impairment in multiple sclerosis
  54. Compilation of a self-management assessment scale for postoperative patients with aortic dissection
  55. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation
  56. Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study
  57. Clinical characteristics and assessment of risk factors in patients with influenza A-induced severe pneumonia after the prevalence of SARS-CoV-2
  58. Analgesia nociception index is an indicator of laparoscopic trocar insertion-induced transient nociceptive stimuli
  59. High STAT4 expression correlates with poor prognosis in acute myeloid leukemia and facilitates disease progression by upregulating VEGFA expression
  60. Factors influencing cardiovascular system-related post-COVID-19 sequelae: A single-center cohort study
  61. HOXD10 regulates intestinal permeability and inhibits inflammation of dextran sulfate sodium-induced ulcerative colitis through the inactivation of the Rho/ROCK/MMPs axis
  62. Mesenchymal stem cell-derived exosomal miR-26a induces ferroptosis, suppresses hepatic stellate cell activation, and ameliorates liver fibrosis by modulating SLC7A11
  63. Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke
  64. ANO6 (TMEM16F) inhibits gastrointestinal stromal tumor growth and induces ferroptosis
  65. Prognostic value of EIF5A2 in solid tumors: A meta-analysis and bioinformatics analysis
  66. The role of enhanced expression of Cx43 in patients with ulcerative colitis
  67. Choosing a COVID-19 vaccination site might be driven by anxiety and body vigilance
  68. Role of ICAM-1 in triple-negative breast cancer
  69. Cost-effectiveness of ambroxol in the treatment of Gaucher disease type 2
  70. HLA-DRB5 promotes immune thrombocytopenia via activating CD8+ T cells
  71. Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome
  72. Efficacy of tacrolimus monotherapy in primary membranous nephropathy
  73. Mechanisms of Tripterygium wilfordii Hook F on treating rheumatoid arthritis explored by network pharmacology analysis and molecular docking
  74. FBXO45 levels regulated ferroptosis renal tubular epithelial cells in a model of diabetic nephropathy by PLK1
  75. Optimizing anesthesia strategies to NSCLC patients in VATS procedures: Insights from drug requirements and patient recovery patterns
  76. Alpha-lipoic acid upregulates the PPARγ/NRF2/GPX4 signal pathway to inhibit ferroptosis in the pathogenesis of unexplained recurrent pregnancy loss
  77. Correlation between fat-soluble vitamin levels and inflammatory factors in paediatric community-acquired pneumonia: A prospective study
  78. CD1d affects the proliferation, migration, and apoptosis of human papillary thyroid carcinoma TPC-1 cells via regulating MAPK/NF-κB signaling pathway
  79. miR-let-7a inhibits sympathetic nerve remodeling after myocardial infarction by downregulating the expression of nerve growth factor
  80. Immune response analysis of solid organ transplantation recipients inoculated with inactivated COVID-19 vaccine: A retrospective analysis
  81. The H2Valdien derivatives regulate the epithelial–mesenchymal transition of hepatoma carcinoma cells through the Hedgehog signaling pathway
  82. Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets
  83. Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis
  84. Lycopene inhibits pyroptosis of endothelial progenitor cells induced by ox-LDL through the AMPK/mTOR/NLRP3 pathway
  85. Methylation regulation for FUNDC1 stability in childhood leukemia was up-regulated and facilitates metastasis and reduces ferroptosis of leukemia through mitochondrial damage by FBXL2
  86. Correlation of single-fiber electromyography studies and functional status in patients with amyotrophic lateral sclerosis
  87. Risk factors of postoperative airway obstruction complications in children with oral floor mass
  88. Expression levels and clinical significance of serum miR-19a/CCL20 in patients with acute cerebral infarction
  89. Physical activity and mental health trends in Korean adolescents: Analyzing the impact of the COVID-19 pandemic from 2018 to 2022
  90. Evaluating anemia in HIV-infected patients using chest CT
  91. Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court
  92. Causal association of circulating immune cells and lymphoma: A Mendelian randomization study
  93. Assessment of the renal function and fibrosis indexes of conventional western medicine with Chinese medicine for dredging collaterals on treating renal fibrosis: A systematic review and meta-analysis
  94. Comprehensive landscape of integrator complex subunits and their association with prognosis and tumor microenvironment in gastric cancer
  95. New target-HMGCR inhibitors for the treatment of primary sclerosing cholangitis: A drug Mendelian randomization study
  96. Population pharmacokinetics of meropenem in critically ill patients
  97. Comparison of the ability of newly inflammatory markers to predict complicated appendicitis
  98. Comparative morphology of the cruciate ligaments: A radiological study
  99. Immune landscape of hepatocellular carcinoma: The central role of TP53-inducible glycolysis and apoptosis regulator
  100. Serum SIRT3 levels in epilepsy patients and its association with clinical outcomes and severity: A prospective observational study
  101. SHP-1 mediates cigarette smoke extract-induced epithelial–mesenchymal transformation and inflammation in 16HBE cells
  102. Acute hyper-hypoxia accelerates the development of depression in mice via the IL-6/PGC1α/MFN2 signaling pathway
  103. The GJB3 correlates with the prognosis, immune cell infiltration, and therapeutic responses in lung adenocarcinoma
  104. Physical fitness and blood parameters outcomes of breast cancer survivor in a low-intensity circuit resistance exercise program
  105. Exploring anesthetic-induced gene expression changes and immune cell dynamics in atrial tissue post-coronary artery bypass graft surgery
  106. Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism
  107. Analysis of the risk factors of the radiation-induced encephalopathy in nasopharyngeal carcinoma: A retrospective cohort study
  108. Reproductive outcomes in women with BRCA 1/2 germline mutations: A retrospective observational study and literature review
  109. Evaluation of upper airway ultrasonographic measurements in predicting difficult intubation: A cross-section of the Turkish population
  110. Prognostic and diagnostic value of circulating IGFBP2 in pancreatic cancer
  111. Postural stability after operative reconstruction of the AFTL in chronic ankle instability comparing three different surgical techniques
  112. Research trends related to emergence agitation in the post-anaesthesia care unit from 2001 to 2023: A bibliometric analysis
  113. Frequency and clinicopathological correlation of gastrointestinal polyps: A six-year single center experience
  114. ACSL4 mediates inflammatory bowel disease and contributes to LPS-induced intestinal epithelial cell dysfunction by activating ferroptosis and inflammation
  115. Affibody-based molecular probe 99mTc-(HE)3ZHER2:V2 for non-invasive HER2 detection in ovarian and breast cancer xenografts
  116. Effectiveness of nutritional support for clinical outcomes in gastric cancer patients: A meta-analysis of randomized controlled trials
  117. The relationship between IFN-γ, IL-10, IL-6 cytokines, and severity of the condition with serum zinc and Fe in children infected with Mycoplasma pneumoniae
  118. Paraquat disrupts the blood–brain barrier by increasing IL-6 expression and oxidative stress through the activation of PI3K/AKT signaling pathway
  119. Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case–control study
  120. Dioscin protects against chronic prostatitis through the TLR4/NF-κB pathway
  121. Association of polymorphisms in FBN1, MYH11, and TGF-β signaling-related genes with susceptibility of sporadic thoracic aortic aneurysm and dissection in the Zhejiang Han population
  122. Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy
  123. Laboratory variables‐based artificial neural network models for predicting fatty liver disease: A retrospective study
  124. Decreased BIRC5-206 promotes epithelial–mesenchymal transition in nasopharyngeal carcinoma through sponging miR-145-5p
  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
  127. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures
  128. The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial
  129. Long intergenic noncoding RNA for IGF2BP2 stability suppresses gastric cancer cell apoptosis by inhibiting the maturation of microRNA-34a
  130. Role of FOXM1 and AURKB in regulating keratinocyte function in psoriasis
  131. Parental control attitudes over their pre-school children’s diet
  132. The role of auto-HSCT in extranodal natural killer/T cell lymphoma
  133. Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy
  134. Echinacoside inhibits PASMCs calcium overload to prevent hypoxic pulmonary artery remodeling by regulating TRPC1/4/6 and calmodulin
  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
  136. The risk of cancer among insulin glargine users in Lithuania: A retrospective population-based study
  137. The unusual location of primary hydatid cyst: A case series study
  138. Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation
  139. Obesity and risk of placenta accreta spectrum: A meta-analysis
  140. Shikonin alleviates asthma phenotypes in mice via an airway epithelial STAT3-dependent mechanism
  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
  152. Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy
  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
  155. Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction
  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
  169. Differences in mortality risk by levels of physical activity among persons with disabilities in South Korea
  170. Review Articles
  171. Cutaneous signs of selected cardiovascular disorders: A narrative review
  172. XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis
  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
  187. CBD’s potential impact on Parkinson’s disease: An updated overview
  188. Progress in cytokine research for ARDS: A comprehensive review
  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
  191. Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review
  192. Trends and future directions of autophagy in osteosarcoma: A bibliometric analysis
  193. Iron in ventricular remodeling and aneurysms post-myocardial infarction
  194. Case Reports
  195. Sirolimus potentiated angioedema: A case report and review of the literature
  196. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
  197. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman’s disease: A case report
  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
  201. Advancing prenatal diagnosis: Echocardiographic detection of Scimitar syndrome in China – A case series
  202. Outcomes and complications of hemodialysis in patients with renal cancer following bilateral nephrectomy
  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
  217. Elevated mRNA level indicates FSIP1 promotes EMT and gastric cancer progression by regulating fibroblasts in tumor microenvironment
  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
  221. SENP7 inhibits glioblastoma metastasis and invasion by dissociating SUMO2/3 binding to specific target proteins
  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
  223. Analysis of postoperative complications in bladder cancer patients
  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
  226. Comprehensive pan-cancer investigation of carnosine dipeptidase 1 and its prospective prognostic significance in hepatocellular carcinoma
  227. Identification of signatures associated with microsatellite instability and immune characteristics to predict the prognostic risk of colon cancer
  228. Single-cell analysis identified key macrophage subpopulations associated with atherosclerosis
https://doi.org/10.1515/med-2023-0851
Keywords for this article
hepatic venous pressure gradient measurement; HCC; advanced chronic liver disease; liver resection; clinically significant portal hypertension
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. EDNRB inhibits the growth and migration of prostate cancer cells by activating the cGMP-PKG pathway
  3. STK11 (LKB1) mutation suppresses ferroptosis in lung adenocarcinoma by facilitating monounsaturated fatty acid synthesis
  4. Association of SOX6 gene polymorphisms with Kashin-Beck disease risk in the Chinese Han population
  5. The pyroptosis-related signature predicts prognosis and influences the tumor immune microenvironment in dedifferentiated liposarcoma
  6. METTL3 attenuates ferroptosis sensitivity in lung cancer via modulating TFRC
  7. Identification and validation of molecular subtypes and prognostic signature for stage I and stage II gastric cancer based on neutrophil extracellular traps
  8. Novel lumbar plexus block versus femoral nerve block for analgesia and motor recovery after total knee arthroplasty
  9. Correlation between ABCB1 and OLIG2 polymorphisms and the severity and prognosis of patients with cerebral infarction
  10. Study on the radiotherapy effect and serum neutral granulocyte lymphocyte ratio and inflammatory factor expression of nasopharyngeal carcinoma
  11. Transcriptome analysis of effects of Tecrl deficiency on cardiometabolic and calcium regulation in cardiac tissue
  12. Aflatoxin B1 induces infertility, fetal deformities, and potential therapies
  13. Serum levels of HMW adiponectin and its receptors are associated with cytokine levels and clinical characteristics in chronic obstructive pulmonary disease
  14. METTL3-mediated methylation of CYP2C19 mRNA may aggravate clopidogrel resistance in ischemic stroke patients
  15. Understand how machine learning impact lung cancer research from 2010 to 2021: A bibliometric analysis
  16. Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay
  17. Metformin plus L-carnitine enhances brown/beige adipose tissue activity via Nrf2/HO-1 signaling to reduce lipid accumulation and inflammation in murine obesity
  18. Downregulation of carbonic anhydrase IX expression in mouse xenograft nasopharyngeal carcinoma model via doxorubicin nanobubble combined with ultrasound
  19. Feasibility of 3-dimensional printed models in simulated training and teaching of transcatheter aortic valve replacement
  20. miR-335-3p improves type II diabetes mellitus by IGF-1 regulating macrophage polarization
  21. The analyses of human MCPH1 DNA repair machinery and genetic variations
  22. Activation of Piezo1 increases the sensitivity of breast cancer to hyperthermia therapy
  23. Comprehensive analysis based on the disulfidptosis-related genes identifies hub genes and immune infiltration for pancreatic adenocarcinoma
  24. Changes of serum CA125 and PGE2 before and after high-intensity focused ultrasound combined with GnRH-a in treatment of patients with adenomyosis
  25. The clinical value of the hepatic venous pressure gradient in patients undergoing hepatic resection for hepatocellular carcinoma with or without liver cirrhosis
  26. Development and validation of a novel model to predict pulmonary embolism in cardiology suspected patients: A 10-year retrospective analysis
  27. Downregulation of lncRNA XLOC_032768 in diabetic patients predicts the occurrence of diabetic nephropathy
  28. Circ_0051428 targeting miR-885-3p/MMP2 axis enhances the malignancy of cervical cancer
  29. Effectiveness of ginkgo diterpene lactone meglumine on cognitive function in patients with acute ischemic stroke
  30. The construction of a novel prognostic prediction model for glioma based on GWAS-identified prognostic-related risk loci
  31. Evaluating the impact of childhood BMI on the risk of coronavirus disease 2019: A Mendelian randomization study
  32. Lactate dehydrogenase to albumin ratio is associated with in-hospital mortality in patients with acute heart failure: Data from the MIMIC-III database
  33. CD36-mediated podocyte lipotoxicity promotes foot process effacement
  34. Efficacy of etonogestrel subcutaneous implants versus the levonorgestrel-releasing intrauterine system in the conservative treatment of adenomyosis
  35. FLRT2 mediates chondrogenesis of nasal septal cartilage and mandibular condyle cartilage
  36. Challenges in treating primary immune thrombocytopenia patients undergoing COVID-19 vaccination: A retrospective study
  37. Let-7 family regulates HaCaT cell proliferation and apoptosis via the ΔNp63/PI3K/AKT pathway
  38. Phospholipid transfer protein ameliorates sepsis-induced cardiac dysfunction through NLRP3 inflammasome inhibition
  39. Postoperative cognitive dysfunction in elderly patients with colorectal cancer: A randomized controlled study comparing goal-directed and conventional fluid therapy
  40. Long-pulsed ultrasound-mediated microbubble thrombolysis in a rat model of microvascular obstruction
  41. High SEC61A1 expression predicts poor outcome of acute myeloid leukemia
  42. Comparison of polymerase chain reaction and next-generation sequencing with conventional urine culture for the diagnosis of urinary tract infections: A meta-analysis
  43. Secreted frizzled-related protein 5 protects against renal fibrosis by inhibiting Wnt/β-catenin pathway
  44. Pan-cancer and single-cell analysis of actin cytoskeleton genes related to disulfidptosis
  45. Overexpression of miR-532-5p restrains oxidative stress response of chondrocytes in nontraumatic osteonecrosis of the femoral head by inhibiting ABL1
  46. Autologous liver transplantation for unresectable hepatobiliary malignancies in enhanced recovery after surgery model
  47. Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section
  48. Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study
  49. No genetic causality between obesity and benign paroxysmal vertigo: A two-sample Mendelian randomization study
  50. Identification and validation of autophagy-related genes in SSc
  51. Long non-coding RNA SRA1 suppresses radiotherapy resistance in esophageal squamous cell carcinoma by modulating glycolytic reprogramming
  52. Evaluation of quality of life in patients with schizophrenia: An inpatient social welfare institution-based cross-sectional study
  53. The possible role of oxidative stress marker glutathione in the assessment of cognitive impairment in multiple sclerosis
  54. Compilation of a self-management assessment scale for postoperative patients with aortic dissection
  55. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation
  56. Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study
  57. Clinical characteristics and assessment of risk factors in patients with influenza A-induced severe pneumonia after the prevalence of SARS-CoV-2
  58. Analgesia nociception index is an indicator of laparoscopic trocar insertion-induced transient nociceptive stimuli
  59. High STAT4 expression correlates with poor prognosis in acute myeloid leukemia and facilitates disease progression by upregulating VEGFA expression
  60. Factors influencing cardiovascular system-related post-COVID-19 sequelae: A single-center cohort study
  61. HOXD10 regulates intestinal permeability and inhibits inflammation of dextran sulfate sodium-induced ulcerative colitis through the inactivation of the Rho/ROCK/MMPs axis
  62. Mesenchymal stem cell-derived exosomal miR-26a induces ferroptosis, suppresses hepatic stellate cell activation, and ameliorates liver fibrosis by modulating SLC7A11
  63. Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke
  64. ANO6 (TMEM16F) inhibits gastrointestinal stromal tumor growth and induces ferroptosis
  65. Prognostic value of EIF5A2 in solid tumors: A meta-analysis and bioinformatics analysis
  66. The role of enhanced expression of Cx43 in patients with ulcerative colitis
  67. Choosing a COVID-19 vaccination site might be driven by anxiety and body vigilance
  68. Role of ICAM-1 in triple-negative breast cancer
  69. Cost-effectiveness of ambroxol in the treatment of Gaucher disease type 2
  70. HLA-DRB5 promotes immune thrombocytopenia via activating CD8+ T cells
  71. Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome
  72. Efficacy of tacrolimus monotherapy in primary membranous nephropathy
  73. Mechanisms of Tripterygium wilfordii Hook F on treating rheumatoid arthritis explored by network pharmacology analysis and molecular docking
  74. FBXO45 levels regulated ferroptosis renal tubular epithelial cells in a model of diabetic nephropathy by PLK1
  75. Optimizing anesthesia strategies to NSCLC patients in VATS procedures: Insights from drug requirements and patient recovery patterns
  76. Alpha-lipoic acid upregulates the PPARγ/NRF2/GPX4 signal pathway to inhibit ferroptosis in the pathogenesis of unexplained recurrent pregnancy loss
  77. Correlation between fat-soluble vitamin levels and inflammatory factors in paediatric community-acquired pneumonia: A prospective study
  78. CD1d affects the proliferation, migration, and apoptosis of human papillary thyroid carcinoma TPC-1 cells via regulating MAPK/NF-κB signaling pathway
  79. miR-let-7a inhibits sympathetic nerve remodeling after myocardial infarction by downregulating the expression of nerve growth factor
  80. Immune response analysis of solid organ transplantation recipients inoculated with inactivated COVID-19 vaccine: A retrospective analysis
  81. The H2Valdien derivatives regulate the epithelial–mesenchymal transition of hepatoma carcinoma cells through the Hedgehog signaling pathway
  82. Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets
  83. Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis
  84. Lycopene inhibits pyroptosis of endothelial progenitor cells induced by ox-LDL through the AMPK/mTOR/NLRP3 pathway
  85. Methylation regulation for FUNDC1 stability in childhood leukemia was up-regulated and facilitates metastasis and reduces ferroptosis of leukemia through mitochondrial damage by FBXL2
  86. Correlation of single-fiber electromyography studies and functional status in patients with amyotrophic lateral sclerosis
  87. Risk factors of postoperative airway obstruction complications in children with oral floor mass
  88. Expression levels and clinical significance of serum miR-19a/CCL20 in patients with acute cerebral infarction
  89. Physical activity and mental health trends in Korean adolescents: Analyzing the impact of the COVID-19 pandemic from 2018 to 2022
  90. Evaluating anemia in HIV-infected patients using chest CT
  91. Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court
  92. Causal association of circulating immune cells and lymphoma: A Mendelian randomization study
  93. Assessment of the renal function and fibrosis indexes of conventional western medicine with Chinese medicine for dredging collaterals on treating renal fibrosis: A systematic review and meta-analysis
  94. Comprehensive landscape of integrator complex subunits and their association with prognosis and tumor microenvironment in gastric cancer
  95. New target-HMGCR inhibitors for the treatment of primary sclerosing cholangitis: A drug Mendelian randomization study
  96. Population pharmacokinetics of meropenem in critically ill patients
  97. Comparison of the ability of newly inflammatory markers to predict complicated appendicitis
  98. Comparative morphology of the cruciate ligaments: A radiological study
  99. Immune landscape of hepatocellular carcinoma: The central role of TP53-inducible glycolysis and apoptosis regulator
  100. Serum SIRT3 levels in epilepsy patients and its association with clinical outcomes and severity: A prospective observational study
  101. SHP-1 mediates cigarette smoke extract-induced epithelial–mesenchymal transformation and inflammation in 16HBE cells
  102. Acute hyper-hypoxia accelerates the development of depression in mice via the IL-6/PGC1α/MFN2 signaling pathway
  103. The GJB3 correlates with the prognosis, immune cell infiltration, and therapeutic responses in lung adenocarcinoma
  104. Physical fitness and blood parameters outcomes of breast cancer survivor in a low-intensity circuit resistance exercise program
  105. Exploring anesthetic-induced gene expression changes and immune cell dynamics in atrial tissue post-coronary artery bypass graft surgery
  106. Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism
  107. Analysis of the risk factors of the radiation-induced encephalopathy in nasopharyngeal carcinoma: A retrospective cohort study
  108. Reproductive outcomes in women with BRCA 1/2 germline mutations: A retrospective observational study and literature review
  109. Evaluation of upper airway ultrasonographic measurements in predicting difficult intubation: A cross-section of the Turkish population
  110. Prognostic and diagnostic value of circulating IGFBP2 in pancreatic cancer
  111. Postural stability after operative reconstruction of the AFTL in chronic ankle instability comparing three different surgical techniques
  112. Research trends related to emergence agitation in the post-anaesthesia care unit from 2001 to 2023: A bibliometric analysis
  113. Frequency and clinicopathological correlation of gastrointestinal polyps: A six-year single center experience
  114. ACSL4 mediates inflammatory bowel disease and contributes to LPS-induced intestinal epithelial cell dysfunction by activating ferroptosis and inflammation
  115. Affibody-based molecular probe 99mTc-(HE)3ZHER2:V2 for non-invasive HER2 detection in ovarian and breast cancer xenografts
  116. Effectiveness of nutritional support for clinical outcomes in gastric cancer patients: A meta-analysis of randomized controlled trials
  117. The relationship between IFN-γ, IL-10, IL-6 cytokines, and severity of the condition with serum zinc and Fe in children infected with Mycoplasma pneumoniae
  118. Paraquat disrupts the blood–brain barrier by increasing IL-6 expression and oxidative stress through the activation of PI3K/AKT signaling pathway
  119. Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case–control study
  120. Dioscin protects against chronic prostatitis through the TLR4/NF-κB pathway
  121. Association of polymorphisms in FBN1, MYH11, and TGF-β signaling-related genes with susceptibility of sporadic thoracic aortic aneurysm and dissection in the Zhejiang Han population
  122. Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy
  123. Laboratory variables‐based artificial neural network models for predicting fatty liver disease: A retrospective study
  124. Decreased BIRC5-206 promotes epithelial–mesenchymal transition in nasopharyngeal carcinoma through sponging miR-145-5p
  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
  127. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures
  128. The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial
  129. Long intergenic noncoding RNA for IGF2BP2 stability suppresses gastric cancer cell apoptosis by inhibiting the maturation of microRNA-34a
  130. Role of FOXM1 and AURKB in regulating keratinocyte function in psoriasis
  131. Parental control attitudes over their pre-school children’s diet
  132. The role of auto-HSCT in extranodal natural killer/T cell lymphoma
  133. Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy
  134. Echinacoside inhibits PASMCs calcium overload to prevent hypoxic pulmonary artery remodeling by regulating TRPC1/4/6 and calmodulin
  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
  136. The risk of cancer among insulin glargine users in Lithuania: A retrospective population-based study
  137. The unusual location of primary hydatid cyst: A case series study
  138. Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation
  139. Obesity and risk of placenta accreta spectrum: A meta-analysis
  140. Shikonin alleviates asthma phenotypes in mice via an airway epithelial STAT3-dependent mechanism
  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
  152. Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy
  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
  155. Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction
  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
  169. Differences in mortality risk by levels of physical activity among persons with disabilities in South Korea
  170. Review Articles
  171. Cutaneous signs of selected cardiovascular disorders: A narrative review
  172. XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis
  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
  187. CBD’s potential impact on Parkinson’s disease: An updated overview
  188. Progress in cytokine research for ARDS: A comprehensive review
  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
  191. Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review
  192. Trends and future directions of autophagy in osteosarcoma: A bibliometric analysis
  193. Iron in ventricular remodeling and aneurysms post-myocardial infarction
  194. Case Reports
  195. Sirolimus potentiated angioedema: A case report and review of the literature
  196. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
  197. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman’s disease: A case report
  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
  201. Advancing prenatal diagnosis: Echocardiographic detection of Scimitar syndrome in China – A case series
  202. Outcomes and complications of hemodialysis in patients with renal cancer following bilateral nephrectomy
  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
  217. Elevated mRNA level indicates FSIP1 promotes EMT and gastric cancer progression by regulating fibroblasts in tumor microenvironment
  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
  221. SENP7 inhibits glioblastoma metastasis and invasion by dissociating SUMO2/3 binding to specific target proteins
  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
  223. Analysis of postoperative complications in bladder cancer patients
  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
  226. Comprehensive pan-cancer investigation of carnosine dipeptidase 1 and its prospective prognostic significance in hepatocellular carcinoma
  227. Identification of signatures associated with microsatellite instability and immune characteristics to predict the prognostic risk of colon cancer
  228. Single-cell analysis identified key macrophage subpopulations associated with atherosclerosis
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 5.11.2025 from https://www.degruyterbrill.com/document/doi/10.1515/med-2023-0851/html
Scroll to top button