Hüsing-Kabar A, Meister T, Köhler M, Domschke W, Kabar I, Wilms C, Hild B, Schmidt H H, Heinzow H S
1Department of Transplant Medicine, University Hospital Muenster, Muenster, Germany.
Department of Gastroenterology, HELIOS Albert-Schweitzer-Hospital Northeim, Northeim, Germany.
United European Gastroenterol J. 2018 Apr;6(3):413-421. doi: 10.1177/2050640617732886. Epub 2017 Sep 20.
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.
This study aimed to explore the association between transjugular intrahepatic portosystemic shunt placement and the development of hepatocellular cancer.
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).
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 ( = 0.003) in the emergence of hepatocellular cancer regarding transjugular intrahepatic portosystemic shunt placement versus the non-transjugular intrahepatic portosystemic shunt cohort.
In patients with end-stage liver disease, transjugular intrahepatic portosystemic shunt insertion is significantly associated with reduced rates of hepatocellular cancer development.
门静脉高压是肝硬化的主要并发症。经颈静脉肝内门体分流术在治疗门静脉高压方面有效。然而，经颈静脉肝内门体分流术置入后肝实质门静脉血流减少有利于缺血性肝损伤，有人认为这会诱发肝癌发生，导致肝细胞癌。
本研究旨在探讨经颈静脉肝内门体分流术与肝细胞癌发生之间的关联。
本回顾性研究纳入了2004年1月至2015年12月期间连续收治的1338例肝硬化患者。分析随访期间肝细胞癌的发生情况。采用二元逻辑回归和Kaplan-Meier分析评估肝细胞癌发生的危险因素。第二步，为排除组间异质性的混杂因素，根据性别、年龄、终末期肝病模型评分和肝硬化的潜在病因（非酒精性脂肪性肝炎、酒精性肝病和病毒性肝炎）进行病例对照匹配。
除年龄较大、男性性别和潜在病毒性肝炎等已确定的危险因素外，统计分析显示未进行经颈静脉肝内门体分流术置入不是肝细胞癌发生的危险因素。此外，对432例患者的配对分析显示，在肝细胞癌的发生方面，经颈静脉肝内门体分流术置入组与非经颈静脉肝内门体分流术组之间存在显著差异（P = 0.003）。
在终末期肝病患者中，经颈静脉肝内门体分流术置入与肝细胞癌发生率降低显著相关。
