Portal hypertension and hepatocellular carcinoma: Des liaisons dangereuses horizontal ellipsis

Background and Aims Portal hypertension (PHT) and hepatocellular carcinoma (HCC) are major complication of cirrhosis which significantly contribute to morbidity and mortality. In this review, we aim to describe the consequences of both angiogenesis and inflammation in the pathogenesis of PHT and HCC, but also the difficulty to propose adapted treatment when PHT and HCC coexist in the same patients. Methods Studies for review in this article were retrieved from the PubMed database using literature published in English until March 2021. Results Portal hypertension occurs secondary to an increase of intrahepatic vascular resistances, the opening of portosystemic collateral vessels and the formation of neovessels, related to vascular endothelial growth factor (VEGF). Recently, bacterial translocation-mediated inflammation was also identified as a major contributor to PHT. Interestingly, VEGF and chronic inflammation also contribute to HCC occurrence. As PHT and HCC often coexist in the same patient, management of PHT and its related complications as well as HCC treatment appear more complex. Indeed, PHT-related complications such as significant ascites may hamper the access to HCC treatment and the presence of HCC is also independently associated with poor prognosis in patients with acute variceal bleeding related to PHT. Due to their respective mechanism of action, the combination of Atezolizumab and Bevacizumab for advanced HCC may impact the level of PHT and its related complications and to date, no real-life data are available. Conslusions Appropriate evaluation and treatment of PHT remains a major issue in order to improve the outcome of HCC patients.

Automated summary

The review highlights the complications of portal hypertension and hepatocellular carcinoma in cirrhosis patients, emphasizing the challenges in treatment when both conditions coexist. Studies suggest that the combination of Atezolizumab and Bevacizumab may impact portal hypertension levels and related complications, but real-life data are lacking to support this. Management of portal hypertension remains crucial to improve outcomes for patients with hepatocellular carcinoma.