Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Acta Obstet Gynecol Scand. 2024 Apr;103(4):653-659. doi: 10.1111/aogs.14640. Epub 2023 Aug 2.
Hepatocellular carcinoma (HCC) is the most frequent primary malignant liver tumor and typically develops in the context of chronic liver disease, such as liver cirrhosis or chronic hepatitis B virus infection. Ultrasound evaluation, CT scan, and MRI are used to detect HCC. α-fetoprotein (AFP) is a common marker used to detect HCC in the non-pregnant population, which notoriously increases in pregnant women in relation to gestational age. Treatment is driven by the extent of the disease and the severity of underlying liver disease. Pregnancy may represent an obstacle to diagnosis and appropriate treatment of HCC. The aim of this descriptive systematic review was to describe the clinical features and maternal and neonatal outcomes of HCC in pregnancy.
We performed a systematic review of the literature about HCC diagnosed in pregnancy and the postpartum period, with signs or symptoms arising in pregnancy. We included case reports and case series describing the clinical features of women diagnosed with HCC, fibrolamellar variant of HCC, and mixed HCC and cholangiocarcinoma during pregnancy or the postpartum period (with onset of symptoms during pregnancy), from inception to March 2023. The study protocol was registered with the PROSPERO database (Registration number: ID CRD42021275584).
We identified 180 records. The articles included in this systematic review were 47 case reports and 5 case series, for a total of 63 pregnancies. The two most frequent predisposing conditions were hepatitis B virus infection (30/63; 47%) and liver cirrhosis (14/63; 22%). Ultrasound evaluation was the most used technique to detect HCC. AFP was higher than normal in 28/46 patients tested (61%). Surgical treatment was the most used therapy, both during pregnancy and after delivery. Twenty-six patients (26/63; 42%) died within 6 months of diagnosis. Survival >24 months was 9% (4/46) in symptomatic and 29% (5/17) in asymptomatic women. No patient with cirrhotic liver survived more than 12 months. Thirty-eight newborns were alive at 28 days of age (38/63; 61%).
Hepatocellular carcinoma in pregnancy is associated with a high risk of maternal and neonatal mortality. Diagnosis in asymptomatic high-risk women or following abnormal maternal serum AFP screening is associated with better maternal outcomes.
肝细胞癌（HCC）是最常见的原发性肝脏恶性肿瘤，通常发生在慢性肝病的背景下，如肝硬化或慢性乙型肝炎病毒感染。超声检查、CT 扫描和 MRI 用于检测 HCC。甲胎蛋白（AFP）是一种常用的标记物，用于检测非妊娠人群中的 HCC，但在妊娠妇女中，随着妊娠龄的增加，AFP 明显升高。治疗方案取决于疾病的严重程度和基础肝病的严重程度。妊娠可能成为诊断和适当治疗 HCC 的障碍。本描述性系统评价的目的是描述妊娠期间 HCC 的临床特征以及母婴和新生儿结局。
我们对妊娠和产后期间诊断为 HCC 的文献进行了系统评价，这些病例的临床表现是在妊娠期间出现或妊娠期间出现症状。我们纳入了描述在妊娠或产后期间（症状出现于妊娠期间）诊断为 HCC、纤维板层变异型 HCC 和混合 HCC 和胆管癌的女性的临床特征的病例报告和病例系列，自开始至 2023 年 3 月。该研究方案已在 PROSPERO 数据库中注册（注册号：ID CRD42021275584）。
我们确定了 180 条记录。本系统评价纳入的文章包括 47 份病例报告和 5 个病例系列，共 63 例妊娠。最常见的两种潜在疾病是乙型肝炎病毒感染（30/63；47%）和肝硬化（14/63；22%）。超声检查是最常用的检测 HCC 的技术。在 28 名接受检测的患者中（28/46；61%），甲胎蛋白高于正常水平。手术治疗是最常用的治疗方法，无论是在怀孕期间还是分娩后。26 名患者（26/63；42%）在诊断后 6 个月内死亡。有症状的患者中，24 个月以上的生存率为 9%（4/46），无症状的患者为 29%（5/17）。没有肝硬化的患者存活时间超过 12 个月。38 名新生儿在 28 天龄时存活（38/63；61%）。
妊娠合并肝细胞癌与母婴死亡率高相关。在无症状高危女性中或在异常母体血清 AFP 筛查后进行诊断与更好的母婴结局相关。
