Is de novo hepatocellular carcinoma after transjugular intrahepatic portosystemic shunt increased?
Is de novo hepatocellular carcinoma after transjugular intrahepatic portosystemic shunt increased?
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DOI：
10.1177/2050640617732886
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发表时间：
2018-04-01
影响因子：
6
通讯作者：
Heinzow, H. S.
中科院分区：
文献类型：
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作者：
Husing-Kabar, A.;Meister, T.;Heinzow, H. S.
背景：门静脉高压症是肝硬化的主要并发症。经颈静脉肝内门体分流术是治疗门静脉高压症的有效方法。然而，经颈静脉肝内门体分流术后实质门静脉血流量减少，有利于缺血性肝损伤，这已被讨论为诱导肝癌发生，导致肝细胞癌。目的：本研究旨在探讨经颈静脉肝内门体分流术放置和肝细胞癌的发展之间的关系。方法：在2004年1月至2015年12月期间，共有1338名连续肝硬化患者被纳入这项回顾性研究。对随访期间肝细胞癌的发展数据进行了分析。进行二元logistic回归和Kaplan-Meier分析，以评估肝细胞癌发生的风险因素。第二步，为了排除组异质性的混杂因素，根据性别、年龄、终末期肝病评分模型和肝硬化的潜在原因进行病例对照匹配（非酒精性脂肪性肝炎、酒精性肝病和病毒性肝炎）。除了确定的风险因素，如年龄较大，男性和潜在的病毒性肝炎，统计学分析显示，经颈静脉肝内门体分流插入的缺乏是肝细胞癌发展的风险因素。此外，432例患者的配对分析显示，在肝细胞癌的出现，经颈静脉肝内门体分流安置与非经颈静脉肝内门体分流cohol.Conclusion：在终末期肝病患者中，经颈静脉肝内门体分流插入与肝细胞癌的发展率降低显着相关（p=0.003）。
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=0.003) in the emergence of hepatocellular cancer regarding transjugular intrahepatic portosystemic shunt placement versus the non-transjugular 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.