Objective: To identify whether
splenectomy for treatment of
hypersplenism has any impact on development of
hepatocellular carcinoma(HCC) among patients with
liver cirrhosis and
hepatitis. Methods: Patients who underwent
splenectomy for
hypersplenism secondary to
liver cirrhosis and
portal hypertension between January 2008 and December 2012 were included from seven hospitals in China, whereas patients receiving medication treatments for
liver cirrhosis and
portal hypertension (non-
splenectomy) at the same time period among the seven hospitals were included as control groups. In the
splenectomy group, all the patients received open or laparoscopic
splenectomy with or without pericardial devascularization. In contrast, patients in the control group were treated conservatively for
liver cirrhosis and
portal hypertension with medicines (non-
splenectomy) with no invasive treatments, such as transjugular intrahepatic
portosystemic shunt,
splenectomy or
liver transplantation before HCC development. All the patients were routinely screened for HCC development with abdominal ultrasound, liver function and
alpha-fetoprotein every 3 to 6 months. To minimize the selection bias, propensity score matching (PSM) was used to match the baseline data of patients among
splenectomy versus non-
splenectomy groups. The Kaplan-Meier method was used to calculate the overall survival and cumulative incidence of HCC development, and the Log-rank test was used to compare the survival or disease rates between the two groups. Univariate and Cox proportional hazard regression models were used to analyze the potential risk factors associated with development of HCC. Results: A total of 871 patients with
liver cirrhosis and
hypertension were included synchronously from 7 tertiary hospitals. Among them, 407 patients had a history of
splenectomy for
hypersplenism (
splenectomy group), whereas 464 patients who received medical treatment but not
splenectomy (non-
splenectomy group). After PSM,233 pairs of patients were matched in adjusted cohorts. The cumulative incidence of HCC diagnosis at 1,3,5 and 7 years were 1%,6%,7% and 15% in the
splenectomy group, which was significantly lower than 1%,6%,15% and 23% in the non-
splenectomy group (HR=0.53,95%CI:0.31 to 0.91,P=0.028). On multivariable analysis,
splenectomy was independently associated with decreased risk of HCC development (HR=0.55,95%CI:0.32 to 0.95,P=0.031). The cumulative survival rates of all the patients at 1,3,5,and 7 years were 100%,97%,91%,86% in the
splenectomy group,which was similar with that of 100%,97%,92%,84% in the non-
splenectomy group (P=0.899). In total,49 patients (12.0%) among
splenectomy group and 75 patients (16.2%) in non-
splenectomy group developed HCC during the study period, respectively. Compared to patients in non-
splenectomy group, patients who developed HCC after
splenectomy were unlikely to receive curative resection for HCC (12.2% vs. 33.3%,χ²=7.029, P=0.008). Conclusion:
Splenectomy for treatment of
hypersplenism may decrease the risk of HCC development among patients with
liver cirrhosis and
portal hypertension.