The absence of warfarin treatment and situs inversus are associated with the occurrence of hepatocellular carcinoma after Fontan surgery
The absence of warfarin treatment and situs inversus are associated with the occurrence of hepatocellular carcinoma after Fontan surgery
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华法林治疗缺失和反位与Fontan术后肝细胞癌的发生有关
DOI：
10.1007/s00535-021-01842-8
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发表时间：
2022
影响因子：
6.3
通讯作者：
Takehara Tetsuo
中科院分区：
文献类型：
--
作者：
Sakamori Ryotaro;Yamada Ryoko;Tahata Yuki;Kodama Takahiro;Hikita Hayato;Tatsumi Tomohide;Yamada Tomomi;Takehara Tetsuo
背景肝细胞癌是Fontan相关性肝病的长期并发症。然而，FALD患者发生肝细胞癌的危险因素仍不清楚。本研究旨在找出与Fontan手术后肝细胞癌发生相关的因素。方法我们对103例Fontan术后患者进行了回顾性研究。分析肝细胞癌发病率和患者特征。采用COX比例风险模型分析肝癌的危险因素。结果Fontan手术至最终肝脏显像的中位间隔为19.6(1.0~37.7)年。103例患者中，9例发展为肝细胞癌。术后10、20、30年肝癌的累积发病率分别为0%、7%、13%。在单因素分析中，接受Fontan手术的年龄、内翻部位和华法林缺失与肝细胞癌的发生有关。多因素分析确定缺乏华法林(调整后的危险比为22.71%，95%可信区间为3.29-507.1；p= 0.0005)和内翻(调整后的危险比为2.75-105.5；p= 0.002)为危险因素。内翻和华法林缺失率分别为12%和50%。在接受华法林治疗的患者中，20年和30年内肝癌的发病率分别为0%和7%，而在未接受华法林治疗的患者中，20和30年的肝癌发病率分别为14%和21%。非华法林组的肝癌发生率显著高于华法林组(p= 0.006)，内翻部患者的肝癌发生率显著高于内翻部患者(p= 0.004)。结论华法林缺失和内翻部与丰坦手术后肝癌的发生有关。
BackgroundHepatocellular carcinoma (HCC) is a long-term complication of Fontan-associated liver disease (FALD). However, risk factors for HCC in patients with FALD remain unclear. This study aimed to identify factors associated with HCC development post-Fontan procedure.MethodsWe retrospectively examined 103 post-Fontan patients who underwent hepatic imaging at our institution. HCC incidence and patient characteristics were analyzed. A Cox proportional hazards model was used to identify risk factors for HCC.ResultsThe median interval between Fontan surgery and final hepatic imaging was 19.6 (1.0–37.7) years. Among 103 patients, nine developed HCC. The cumulative incidence rates of HCC at 10, 20, and 30 years postoperatively were 0%, 7%, and 13%, respectively. In the univariate analysis, age at Fontan surgery, situs inversus, and warfarin absence were associated with HCC occurrence. The multivariate analysis identified the warfarin absence (adjusted hazard ratio [aHR], 22.71; 95% confidence interval: 3.29–507.1;p= 0.0005) and situs inversus (aHR, 14.36; 95% confidence interval: 2.75–105.5;p= 0.002) as risk factors. The prevalence of situs inversus and the warfarin absence was 12% and 50%, respectively. The 20- and 30-year incidence rates of HCC among patients who received warfarin were 0% and 7%, respectively, while those among patients who did not receive warfarin were 14% and 21%, respectively. HCC incidence was significantly higher in the non-warfarin group than in the warfarin group (p= 0.006) and among patients with situs inversus than among those with situs solitus (p= 0.004).ConclusionsWarfarin absence and situs inversus were associated with HCC development post-Fontan procedure.
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影响因子：
1.5
作者：
Shimizu, Mikiko;Miyamoto, Kenji;Nakanishi, Toshio
通讯作者：
Nakanishi, Toshio
影响因子：
5.7
作者：
Kiesewetter, Christoph H.;Sheron, Nick;Veldtman, Gruschen R.
通讯作者：
Veldtman, Gruschen R.
DOI：
10.1016/j.jtcvs.2013.06.011
发表时间：
2014-04-01
影响因子：
6
作者：
Tomkiewicz-Pajak, Lidia;Hoffman, Piotr;Undas, Anetta
通讯作者：
Undas, Anetta
影响因子：
37.8
作者：
Khairy, Paul;Fernandes, Susan M.;Landzberg, Michael J.
通讯作者：
Landzberg, Michael J.
影响因子：
1.6
作者：
Rychik, Jack;Veldtman, Gruschen;Rand, Elizabeth;Russo, Pierre;Rome, Jonathan J.;Krok, Karen;Goldberg, David J.;Cahill, Anne Marie;Wells, Rebecca G.
通讯作者：
Wells, Rebecca G.