Urhut Cristiana Marinela, Sandulescu Larisa Daniela, Streba Liliana, Iovanescu Vlad Florin, Sandulescu Sarmis Marian, Danoiu Suzana
Department of Gastroenterology, Emergency County Hospital of Craiova, Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Diagnostics (Basel). 2022 May 19;12(5):1270. doi: 10.3390/diagnostics12051270.
In this paper, we aimed to evaluate clinical and imagistic features, and also to provide a diagnostic algorithm for patients presenting with gastrointestinal involvement from hepatocellular carcinoma (HCC). We conducted a systematic search on the PubMed, Scopus and Web of Science databases to identify and collect papers oncases of HCC with gastrointestinal involvement. This search was last updated on 29 April 2022. One hundred and twenty-three articles were included, corresponding to 197 patients. The majority of the patients were male (87.30%), with a mean age of 61.21 years old. The analysis showed large HCCs located mainly in the right hepatic lobe, and highly elevated alfa-fetoprotein (mean = 15,366.18 ng/mL). The most frequent etiological factor was hepatitis B virus (38.57%). Portal vein thrombosis was present in 27.91% of cases. HCC was previously treated in most cases by transarterial chemoembolization (32.99%) and surgical resection (28.93%). Gastrointestinal lesions, developed mainly through direct invasion and hematogenous routes, were predominantly detected in the stomach and duodenum in equal measure-27.91%. Gastrointestinal bleeding was the most common presentation (49.74%). The main diagnostic tools were esophagogastroduodenoscopy (EGD) and computed tomography. The mean survival time was 7.30 months. Gastrointestinal involvement in HCC should be included in the differential diagnosis of patients with underlying HCC and gastrointestinal manifestations or pathological findings in EGD.
在本文中，我们旨在评估临床和影像学特征，并为出现肝细胞癌（HCC）胃肠道受累的患者提供一种诊断算法。我们对PubMed、Scopus和Web of Science数据库进行了系统检索，以识别和收集有关HCC胃肠道受累病例的论文。该检索于2022年4月29日最后更新。纳入了123篇文章，对应197例患者。大多数患者为男性（87.30%），平均年龄为61.21岁。分析显示，大肝癌主要位于右肝叶，甲胎蛋白高度升高（平均值 = 15,366.18 ng/mL）。最常见的病因是乙型肝炎病毒（38.57%）。27.91%的病例存在门静脉血栓形成。在大多数情况下，HCC先前接受过经动脉化疗栓塞（32.99%）和手术切除（28.93%）。胃肠道病变主要通过直接侵犯和血行途径发展，在胃和十二指肠中检测到的比例相等，均为27.91%。胃肠道出血是最常见的表现（49.74%）。主要的诊断工具是食管胃十二指肠镜检查（EGD）和计算机断层扫描。平均生存时间为7.30个月。HCC的胃肠道受累应纳入对患有潜在HCC且有胃肠道表现或EGD病理结果的患者的鉴别诊断中。
