Paul S B, Sreenivas V, Gamanagatti S R, Sharma H, Dhamija E, Acharya S K
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
Aliment Pharmacol Ther. 2015 May;41(10):961-71. doi: 10.1111/apt.13173. Epub 2015 Mar 23.
Frequency of hepatocellular carcinoma (HCC) in hepatic venous outflow tract obstruction (HVOTO) is unclear and risk factors in HVOTO associated with HCC are unknown.
To assess the incidence of HCC and to identify risk factors for HCC in primary HVOTO.
In the consecutive primary HVOTO patients evaluated between 1989 to 2013, the incidence of HCC among HVOTO was assessed in a retrospective cohort study and identification of the risk factors for HCC in HVOTO patients done by a case-control study.
Of the 421 HVOTO patients, 8 had HCC at presentation (prevalence 1.9%). Another 8 of the remaining 413 developed HCC during 2076.2 person-years follow-up (mean 5.03 + 4.65 years, range 0.08-20 years). The cumulative incidence of HCC was 3.5% (95% CI 1.28-9.2%) at 10 years. The case-control study included 16 HCC as cases and remaining 405 as controls. Controls were predominantly males (M:F - 230:175), mean age 29 ± 10.3 years. Cases were predominantly females with an older age of 36.2 ± 11.4 years (P < 0.01, OR = 1.06, CI 1.0-1.10%). Presence of cirrhosis (P < 0.001), combined inferior vena cava (IVC) and hepatic vein (HV) block (P < 0.03, OR = 5.58, CI 1.43-25.30%) and long-segment IVC block (P < 0.02, OR = 6.50, CI 1.32-32.0%) were significantly higher among cases than controls.
Hepatic venous outflow tract obstruction is a risk factor for HCC. The cumulative incidence of HCC in HVOTO is low and progressively increases over time. Those with liver cirrhosis, combined IVC and HV block and long-segment IVC block are at risk to develop HCC and need active surveillance.
肝静脉流出道梗阻（HVOTO）患者中肝细胞癌（HCC）的发生率尚不清楚，且HVOTO中与HCC相关的危险因素也未知。
评估原发性HVOTO中HCC的发生率，并确定其危险因素。
在1989年至2013年期间评估的连续性原发性HVOTO患者中，通过回顾性队列研究评估HVOTO中HCC的发生率，并通过病例对照研究确定HVOTO患者中HCC的危险因素。
在421例HVOTO患者中，8例在就诊时患有HCC（患病率1.9%）。在其余413例患者中，另外8例在2076.2人年的随访期间（平均5.03±4.65年，范围0.08 - 20年）发生了HCC。10年时HCC的累积发生率为3.5%（95%CI 1.28 - 9.2%）。病例对照研究包括16例HCC患者作为病例，其余405例作为对照。对照主要为男性（男：女 = 230：175），平均年龄29±10.3岁。病例主要为女性，年龄较大，为36.2±11.4岁（P < 0.01，OR = 1.06，CI 1.0 - 1.10%）。病例组中肝硬化的存在（P < 0.001）、下腔静脉（IVC）和肝静脉（HV）联合阻塞（P < 0.03，OR = 5.58，CI 1.43 - 25.30%）以及长段IVC阻塞（P < 0.02，OR = 6.50，CI 1.32 - 32.0%）显著高于对照组。
肝静脉流出道梗阻是HCC的一个危险因素。HVOTO中HCC的累积发生率较低，但随时间逐渐增加。患有肝硬化、IVC和HV联合阻塞以及长段IVC阻塞的患者有发生HCC的风险，需要进行积极监测。
