Portal‐hypertension features are associated with ascites occurrence and survival in patients with hepatocellular carcinoma treated by external radiotherapy

Background and Aims We studied the impact of Portal hypertension (PHT) on ascites occurrence and on radiotherapy outcome in cirrhotic patients with hepatocellular carcinoma (HCC). Method All cirrhotic patients that received radiotherapy for HCC between 2012 and 2022 were included. Portal hypertension‐Score was built using univariate analysis with the presence of esophageal varices (EV), platelet count, history of acute variceal bleeding (AVB) and spleen size. Time‐to‐events data were estimated using Kaplan‐Meier method with log‐rank and Cox‐models. Results 60 patients were included (female 27%, age 67 years‐old, Child‐Pugh A 82%, alcoholic/non‐alcoholic steatohepatitis/hepatitis C virus 55/40/32%). 38% and 15% presented history of ascites and AVB respectively, 25% had large EV, 53.5% presented PHT score ≥ 5. 92% were BCLC‐0/A, median tumor size was 30 mm. At 6 months, ascites incidence was 19% and precluded access to further HCC treatment for all patients with HCC recurrence. All PHT parameters included in the score and PHT score ≥ 5 (hazard ratio (HR) = 14.07, p = 0.01) were associated with ascites occurrence. Transplantation free survival and recurrence free survival at 1 year were 56% and 47% respectively. Albi grade 3 (HR = 3.01; p = 0.04) was independently associated with Transplantation free survival. Conclusion Radiotherapy should be cautiously performed in patients with PHT score ≥ 5 because of ascites occurrence risk precluding access to further HCC treatments.