Screening and management for portal hypertension in hepatocellular carcinoma: A nationwide survey in China

INTRODUCTION AND OBJECTIVES: Hepatocellular carcinoma (HCC) and portal hypertension (PHT) are two common complications of cirrhosis that often co-exist and significantly affect patient prognosis, yet global management varies widely. This study evaluated Chinese physicians' perspectives on PHT screening and management in HCC. MATERIALS AND METHODS: An online questionnaire survey was distributed to hepatologists, gastroenterologists, gastrointestinal oncologists, and hepatobiliary surgeons across 132 hospitals in 16 provinces throughout China from March 1, 2024, to June 30, 2024. The questionnaire comprised 57 items across four sections. This study was approved by Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (No. 2024-0365) and registered at the Chinese Clinical Trial Registry (ChiCTR2400084630). RESULTS: Overall, 1,584 participants responded to the questionnaire. The reported PHT screening rate in HCC patients was 82.6%. Imaging was the most common modality (50.5%), followed by endoscopy (30.8%). However, adherence to the Baveno VI/VII consensus was only 28%. Complications of PHT, including gastrointestinal bleeding and ascites, significantly affected physicians' screening practices. The primary and secondary prophylaxis strategies for PHT generally comply with the Baveno VII consensus. A history of acute variceal bleeding within 6 months significantly reduced the preference for atezolizumab and bevacizumab therapy (19.6% vs. 32.9%, P