title: Hepatocellular carcinoma in cirrhotic patients with transjugular intrahepatic portosystemic shunt: a retrospective case-control study.
abstract: BACKGROUND
  An association between Transjugular Intrahepatic Porto-Systemic Shunt (TIPS) and the development of hepatocellular carcinoma in patients with cirrhosis has been suggested, but not confirmed.
  
  
  OBJECTIVE
  To evaluate the potential role of TIPS in hepatocellular carcinoma development.
  
  
  METHODS
  We performed a retrospective case-control study among patients with cirrhosis; all cases had undergone TIPS placement. Cases and controls were followed as outpatients at a single liver care centre in the same timeframe.
  
  
  RESULTS
  Overall, 101 patients with cirrhosis (mean age 58 ± 9 years, 64.3% male) were included in each group. Median duration of follow-up was 56.7 months (range 8.2-174.5) for TIPS patients and 67.8 months (range 8.3-183.1) for controls (p=0.08). In both groups 94% of patients had Child-Pugh Class A or B cirrhosis. The cumulative incidence of hepatocellular carcinoma at 1, 3, 5, and 10 years was 2%, 7%, 18%, and 46% among TIPS patients, and 3%, 10%, 19%, and 39% among controls (log rank test p=0.19). Compared to controls, hepatocellular carcinoma nodules in TIPS patients were more frequently situated in the right lobe (p<0.05).
  
  
  CONCLUSIONS
  TIPS does not seem to increase the risk of hepatocellular carcinoma in patients with Child-Pugh Class A or B cirrhosis; for these patients ultrasound surveillance should not be modified.
authors.affiliation: Department of Clinical Medicine, Division of Gastroenterology, "Sapienza", University of Rome, Rome, Italy. Electronic address: adsdmc@tin.it.
authors.forename: Adriano
authors.initials: A
authors.lastname: De Santis
authors.affiliation: Department of Clinical Medicine, Division of Gastroenterology, "Sapienza", University of Rome, Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Iegri
authors.affiliation: Department of Clinical Medicine, Division of Gastroenterology, "Sapienza", University of Rome, Rome, Italy; Center for Immunobiologicals Research and Evaluation, Italian National Institute of Health, Rome, Italy.
authors.forename: Loreta
authors.initials: L
authors.lastname: Kondili
authors.affiliation: Department of Clinical Medicine, Division of Gastroenterology, "Sapienza", University of Rome, Rome, Italy.
authors.forename: Oliviero
authors.initials: O
authors.lastname: Riggio
authors.affiliation: Department of Radiological Sciences, Oncology and Anatomical Pathology, "Sapienza", University of Rome, Rome, Italy.
authors.forename: Filippo Maria
authors.initials: FM
authors.lastname: Salvatori
authors.affiliation: Department of Radiological Sciences, Oncology and Anatomical Pathology, "Sapienza", University of Rome, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.affiliation: Department of Radiological Sciences, Oncology and Anatomical Pathology, "Sapienza", University of Rome, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Di Martino
authors.affiliation: Department of Clinical Medicine, Division of Gastroenterology, "Sapienza", University of Rome, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bassanelli
authors.affiliation: Department of Clinical Medicine, Division of Gastroenterology, "Sapienza", University of Rome, Rome, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Lupo
authors.affiliation: Department of Radiological Sciences, Oncology and Anatomical Pathology, "Sapienza", University of Rome, Rome, Italy.
authors.forename: Pierleone
authors.initials: P
authors.lastname: Lucatelli
authors.affiliation: Department of Clinical Medicine, Division of Gastroenterology, "Sapienza", University of Rome, Rome, Italy.
authors.forename: Adolfo Francesco
authors.initials: AF
authors.lastname: Attili
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000628:therapy; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014463:Ultrasonography
keywords: Cirrhosis; HCC; HCC incidence; Survival; TIPS; Ultrasound surveillance