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Patients with cirrhosis and bare‐stent TIPS may have increased risk of hepatocellular carcinoma
Author(s) -
Bañares Rafael,
Núñez Oscar,
Escudero María,
Fernández Cristina,
Vaquero Javier,
Beceiro Inmaculada,
Echenagusía Antonio,
Clemente Gerardo,
Santos Leandro
Publication year - 2005
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.20576
Subject(s) - medicine , hepatocellular carcinoma , cirrhosis , transjugular intrahepatic portosystemic shunt , cohort , cumulative incidence , gastroenterology , hazard ratio , incidence (geometry) , retrospective cohort study , hepatitis c , surgery , risk factor , confidence interval , portal hypertension , physics , optics
A trend toward a higher incidence of hepatocelullar carcinoma (HCC) in patients with cirrhosis treated with bare‐stent transjugular intrahepatic portosystemic shunt (TIPS) has been observed in previous studies. To assess the influence of TIPS as a risk factor for developing HCC, we have compared the incidence of HCC in two retrospective cohorts of patients. The TIPS cohort (n = 138) included patients with cirrhosis who underwent TIPS placement for the treatment of portal hypertension–related complications; the non‐TIPS cohort was composed of patients admitted at the hospital at the same time of TIPS insertion who were individually matched 1:1 according to age, sex, Child‐Turcotte‐Pugh class, and cause of cirrhosis. A stratified Cox model was used to assess risk of HCC development. The median time of follow‐up was similar in TIPS and non‐TIPS cohorts (30.3 [range, 7.8‐119.5] and 31.4 [range, 7.8‐110.8] months, respectively). The cumulative probability of developing HCC at 1, 3, and 5 years was 3%, 24%, and 34% for the TIPS cohort and 1%, 6%, and 25%, for the non‐TIPS cohort, respectively (Breslow test = 5.23, P = .022). The adjusted hazard ratio was 1.52 (95% confidence interval, 1.06‐2.19; P = .02). Hepatitis C virus infection and age were independent predictors of HCC development in patients without TIPS. In conclusion , patients with cirrhosis who are treated with TIPS may have a higher incidence of HCC. This observation suggests the need for a strict HCC surveillance program for these patients, especially if they are not expected to undergo a short‐ or medium‐term liver transplantation. (H EPATOLOGY 2005;41:566–571.)