title: Patients with cirrhosis and bare-stent TIPS may have increased risk of hepatocellular carcinoma.
abstract: A trend toward a higher incidence of hepatocelullar carcinoma (HCC) in patients with cirrhosis treated with bare-stent transjugular intrahepatic portosystemic shunt (TIPS) has been observed in previous studies. To assess the influence of TIPS as a risk factor for developing HCC, we have compared the incidence of HCC in two retrospective cohorts of patients. The TIPS cohort (n = 138) included patients with cirrhosis who underwent TIPS placement for the treatment of portal hypertension-related complications; the non-TIPS cohort was composed of patients admitted at the hospital at the same time of TIPS insertion who were individually matched 1:1 according to age, sex, Child-Turcotte-Pugh class, and cause of cirrhosis. A stratified Cox model was used to assess risk of HCC development. The median time of follow-up was similar in TIPS and non-TIPS cohorts (30.3 [range, 7.8-119.5] and 31.4 [range, 7.8-110.8] months, respectively). The cumulative probability of developing HCC at 1, 3, and 5 years was 3%, 24%, and 34% for the TIPS cohort and 1%, 6%, and 25%, for the non-TIPS cohort, respectively (Breslow test = 5.23, P = .022). The adjusted hazard ratio was 1.52 (95% confidence interval, 1.06-2.19; P = .02). Hepatitis C virus infection and age were independent predictors of HCC development in patients without TIPS. In conclusion, patients with cirrhosis who are treated with TIPS may have a higher incidence of HCC. This observation suggests the need for a strict HCC surveillance program for these patients, especially if they are not expected to undergo a short- or medium-term liver transplantation.
authors.affiliation: Liver Unit, Department of Gastroenterology, Hospital Gregorio Marañón, Madrid, Spain. rbarnares@telefonica.net
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
authors.forename: Oscar
authors.initials: O
authors.lastname: Núñez
authors.forename: María
authors.initials: M
authors.lastname: Escudero
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández
authors.forename: Javier
authors.initials: J
authors.lastname: Vaquero
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Beceiro
authors.forename: Antonio
authors.initials: A
authors.lastname: Echenagusía
authors.forename: Gerardo
authors.initials: G
authors.lastname: Clemente
authors.forename: Leandro
authors.initials: L
authors.lastname: Santos
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D011336:Probability; D012189:Retrospective Studies; D012306:Risk