Hepatocellular carcinoma in cirrhotic patients with transjugular intrahepatic portosystemic shunt: A retrospective case–control study

Santis, Adriano De; Iegri, C.; Kondili, Loreta A.; Riggio, Oliviero; Salvatori, Filippo Maria; Catalano, Carlo; Martino, Michele Di; Bassanelli, C.; Lupo, M.; Lucatelli, Pierleone; Attili, Adolfo Francesco

doi:10.1016/j.dld.2014.04.009

Cited by 15 publications

(21 citation statements)

References 22 publications

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“…As such, we randomly selected patients in the non-splenectomy group as controls, which was a previously utilized approach. [5,7,36] Of note, the incidence of HCC in non-splenectomy group was approximately similar to the "natural incidence" of HCC among previously reported hospitalized patients with HBV-and HCV-related liver cirrhosis. [5,7,36]…”

Section: Discussionsupporting

confidence: 82%

“…Although TIPS is not a surgical shunt, it generates circulatory, hemodynamic, and functional changes, and signi cantly in uences hepatocyte proliferation and portal blood ow. [5][6][7][8][9] Several studies have demonstrated that TIPS might increase the risk of HCC development among patients with liver cirrhosis, [5,6] whereas other studies have failed to note this association. [7][8][9] Hypersplenism is characterized by anemia, leucopenia, thrombocytopenia and splenomegaly.…”

Section: Introductionmentioning

confidence: 99%

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Splenectomy May Decrease the Risk of Hepatocellular Carcinoma in Patients with Liver Cirrhosis: A Multi-institutional Cohort Study

Zhang

Liu

et al. 2020

Preprint

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BackgroundHypersplenism is a common consequence of liver cirrhosis and a risk factor of hepatocellular carcinoma (HCC) development. The objective of the current study was to identify whether splenectomy for treatment of hypersplenism has any impact on risk of HCC. MethodsPatients who underwent splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension between 2008 and 2012 were included from seven University Hospitals in China, whereas patients receiving medication treatments for liver cirrhosis and portal hypertension (non-splenectomy) at this time period were also included as control. ResultsA 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, whereas 464 patients who received medical treatment but not splenectomy (non-splenectomy group). The cumulative incidence of HCC development at 1, 3, 5 and 7 years were 1%, 6%, 11% and 16% in splenectomy group, and 2%, 10%, 17% and 24% in non-splenectomy group in the unadjusted cohort (Breslow test = 7.7, p=0.005). Consistently, in the matched cohort, the cumulative rates of HCC diagnosis at 1, 3, 5 and 7 years were 1%, 6%, 7% and 15% in splenectomy group, and 1%, 6%, 15% and 23% in non-splenectomy group (Breslow test = 4.9, p=0.028). On multivariable analysis, splenectomy was independently associated with decreased risk of HCC development (HR 0.55, 95% CI, 0.32-0.95, p=0.031). ConclusionSplenectomy for treatment of hypersplenism may decrease the risk of HCC development.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Splenectomy May Decrease the Risk of Hepatocellular Carcinoma in Patients with Liver Cirrhosis: A Multi-institutional Cohort Study

Zhang

Liu

et al. 2020

Preprint

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“…The median age was 58 years (51-65) in the TIPS group and 58 years (50-65) in the non-TIPS patients. The median MELD score was 12 (10)(11)(12)(13)(14)(15) in the TIPS cohort and 11.7 (9.2-4.4) in the non-TIPS population ( Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…9 However, study data are controversial concerning TIPS and its impact on HCC development. A study by De Santis et al 11 was not able to show a significant association of TIPS with HCC, although a trend towards higher HCC incidence in the TIPS cohort could be detected. Consistent with the data from De Santis et al, 11 in almost all cases of our study population, HCC occurred in lobule of TIPS insertion (right lobe) but this association missed the significance level.…”

mentioning

confidence: 97%

“…A study by De Santis et al 11 was not able to show a significant association of TIPS with HCC, although a trend towards higher HCC incidence in the TIPS cohort could be detected. Consistent with the data from De Santis et al, 11 in almost all cases of our study population, HCC occurred in lobule of TIPS insertion (right lobe) but this association missed the significance level. In contrast, in our investigation we could not detect TIPS to be related to a higher risk for HCC development.…”

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confidence: 97%

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Is de novo hepatocellular carcinoma after transjugular intrahepatic portosystemic shunt increased?

Hüsing‐Kabar

Meister

Köhler

et al. 2017

United European Gastroenterology Journal

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Background: Portal hypertension is a major complication of liver cirrhosis. Transjugular intrahepatic portosystemic shunt is effective in treatment of portal hypertension. However, decreased parenchymal portal venous flow after transjugular intrahepatic portosystemic shunt insertion favours ischaemic liver injury which has been discussed to induce hepatocarcinogenesis causing hepatocellular cancer. Aim: This study aimed to explore the association between transjugular intrahepatic portosystemic shunt placement and the development of hepatocellular cancer. Methods: A total of 1338 consecutive liver cirrhosis patients were included in this retrospective study between January 2004-December 2015. Data were analysed with regard to development of hepatocellular cancer during follow-up. Binary logistic regression and Kaplan-Meier analyses were conducted for the assessment of risk factors for hepatocellular cancer development. In a second step, to rule out confounders of group heterogeneity, case-control matching was performed based on gender, age, model of end-stage liver disease score and underlying cause of cirrhosis (non-alcoholic steatohepatitis, alcoholic liver disease and viral hepatitis). Results: Besides established risk factors such as older age, male gender and underlying viral hepatitis, statistical analysis revealed the absence of transjugular intrahepatic portosystemic shunt insertion as a risk factor for hepatocellular cancer development. Furthermore, matched-pair analysis of 432 patients showed a significant difference (p ¼ 0.003) in the emergence of hepatocellular cancer regarding transjugular intrahepatic portosystemic shunt placement versus the nontransjugular intrahepatic portosystemic shunt cohort. Conclusion: In patients with end-stage liver disease, transjugular intrahepatic portosystemic shunt insertion is significantly associated with reduced rates of hepatocellular cancer development.

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Occult Hepatocellular Carcinoma Associated With Transjugular Intrahepatic Portosystemic Shunts in Liver Transplant Recipients

et al. 2021

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Transplant eligibility for hepatocellular carcinoma (HCC) is determined by the imaging identification of tumor burden within the Milan criteria. Transjugular intrahepatic portosystemic shunt(s) (TIPS) reduce portal hypertension but may impact HCC visualization. It was hypothesized that the presence of pretransplant TIPS would correlate with occult HCC and reduced survival. A single-center, retrospective, case control study was performed among liver transplant recipients with HCC (2000-2017). The primary endpoint was occult disease on explant pathology. Backward stepwise logistic regression was performed. The secondary endpoints disease-free survival (DFS) and overall survival (OS) were evaluated with Kaplan-Meier curves and Cox regression analysis. Of 640 patients, 40 had TIPS and more frequently exhibited occult disease (80.0% versus 43.1%; P < 0.001; odds ratio [OR], 4.16; P < 0.001). Portal vein thrombosis (PVT) similarly correlated with occult disease (OR, 1.97; P = 0.02). Explant tumor burden was equivalent between TIPS subgroups; accordingly, TIPS status was not independently associated with reduced DFS or OS. However, exceeding the Milan criteria was associated with reduced DFS (hazard ratio, 3.21; P = 0.001), and TIPS status in patients with a single suspected lesion (n = 316) independently correlated with explant tumor burdens beyond these criteria (OR, 13.47; P = 0.001). TIPS on pretransplant imaging are associated with occult HCC on explant pathology. Comparable occult disease findings in patients with PVT suggest that the mechanism may involve altered hepatic perfusion, obscuring imaging diagnosis. TIPS are not independently associated with reduced DFS or OS but are associated with exceeding the Milan criteria for patients with a single suspected lesion. The presence of TIPS may necessitate a higher index of suspicion for occult HCC.

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Hepatocellular carcinoma in cirrhotic patients with transjugular intrahepatic portosystemic shunt: A retrospective case–control study

Cited by 15 publications

References 22 publications

Splenectomy May Decrease the Risk of Hepatocellular Carcinoma in Patients with Liver Cirrhosis: A Multi-institutional Cohort Study

Splenectomy May Decrease the Risk of Hepatocellular Carcinoma in Patients with Liver Cirrhosis: A Multi-institutional Cohort Study

Is de novo hepatocellular carcinoma after transjugular intrahepatic portosystemic shunt increased?

Occult Hepatocellular Carcinoma Associated With Transjugular Intrahepatic Portosystemic Shunts in Liver Transplant Recipients

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