De Santis Adriano, Iegri Claudia, Kondili Loreta, Riggio Oliviero, Salvatori Filippo Maria, Catalano Carlo, Di Martino Michele, Bassanelli Chiara, Lupo Marinella, Lucatelli Pierleone, Attili Adolfo Francesco
Department of Clinical Medicine, Division of Gastroenterology, "Sapienza", University of Rome, Rome, Italy.
Department of Clinical Medicine, Division of Gastroenterology, "Sapienza", University of Rome, Rome, Italy.
Dig Liver Dis. 2014 Aug;46(8):726-30. doi: 10.1016/j.dld.2014.04.009. Epub 2014 Jun 2.
An association between Transjugular Intrahepatic Porto-Systemic Shunt (TIPS) and the development of hepatocellular carcinoma in patients with cirrhosis has been suggested, but not confirmed.
To evaluate the potential role of TIPS in hepatocellular carcinoma development.
We performed a retrospective case-control study among patients with cirrhosis; all cases had undergone TIPS placement. Cases and controls were followed as outpatients at a single liver care centre in the same timeframe.
Overall, 101 patients with cirrhosis (mean age 58 ± 9 years, 64.3% male) were included in each group. Median duration of follow-up was 56.7 months (range 8.2-174.5) for TIPS patients and 67.8 months (range 8.3-183.1) for controls (p=0.08). In both groups 94% of patients had Child-Pugh Class A or B cirrhosis. The cumulative incidence of hepatocellular carcinoma at 1, 3, 5, and 10 years was 2%, 7%, 18%, and 46% among TIPS patients, and 3%, 10%, 19%, and 39% among controls (log rank test p=0.19). Compared to controls, hepatocellular carcinoma nodules in TIPS patients were more frequently situated in the right lobe (p<0.05).
TIPS does not seem to increase the risk of hepatocellular carcinoma in patients with Child-Pugh Class A or B cirrhosis; for these patients ultrasound surveillance should not be modified.
经颈静脉肝内门体分流术（TIPS）与肝硬化患者肝细胞癌的发生之间存在关联，但尚未得到证实。
评估TIPS在肝细胞癌发生中的潜在作用。
我们对肝硬化患者进行了一项回顾性病例对照研究；所有病例均接受了TIPS植入。病例组和对照组在同一时间段内在单一肝脏护理中心作为门诊患者进行随访。
总体而言，每组纳入101例肝硬化患者（平均年龄58±9岁，男性占64.3%）。TIPS患者的中位随访时间为56.7个月（范围8.2 - 174.5个月），对照组为67.8个月（范围8.3 - 183.1个月）（p = 0.08）。两组中94%的患者为Child-Pugh A或B级肝硬化。TIPS患者1年、3年、5年和10年肝细胞癌的累积发病率分别为2%、7%、18%和46%，对照组分别为3%、10%、19%和39%（对数秩检验p = 0.19）。与对照组相比，TIPS患者的肝细胞癌结节更常位于右叶（p < 0.05）。
对于Child-Pugh A或B级肝硬化患者，TIPS似乎不会增加肝细胞癌的风险；对于这些患者，不应改变超声监测方案。
