Application of propensity score matching in prognostic analysis of portal hypertension in hepatocellular carcinoma patients

Objective: To investigate the impact of portal hypertension on surgical prognosis after hepatectomy for hepatocellular carcinoma and assess the therapeutic value of concomitant splenic modulation procedures. Methods: O. Patients were categorized as PHT (n = 88) or non-PHT (n = 642). Propensity score matching (1:1) was performed to balance baseline covariates; matched analyses included 59 pairs. Short-term perioperative outcomes and long-term overall survival (OS) and recurrence-free survival (RFS) were compared between groups. Within the PHT cohort, outcomes were compared between hepatectomy alone and hepatectomy combined with splenectomy or splenic artery ligation. Results: Post-PSM analysis (59 matched pairs) revealed worse short-term outcomes in the PHT group: shorter surgical duration (p < 0.05) but greater intraoperative blood loss (anatomical/extensive hepatectomy subgroups, p < 0.01), higher postoperative bilirubin levels (p < 0.05), and longer hospital stay (non-anatomical/non-extensive hepatectomy subgroups, p < 0.01). Long-term OS and RFS showed no differences between groups pre- or post-PSM (p > 0.05). However, subgroup analyses demonstrated superior RFS in non-PHT patients undergoing non-anatomical and non-extensive hepatectomy (p = 0.035/0.034). Notably, pre-PSM data indicated improved RFS and OS in PHT patients receiving concomitant splenectomy or splenic artery ligation versus hepatectomy alone (p < 0.001). Conclusion: Compared with non-PHT patients, PHT was not associated with additional risk factors for poor prognosis after surgery. However, PHT may represent a significant risk indicator for recurrence in HCC patients undergoing non-anatomical or non-extensive hepatectomy. Furthermore, for HCC patients with concomitant PHT, hepatectomy combined with splenic artery ligation or splenectomy was associated with better long-term survival.