PDF(Pubmed)
Abstract：
Transjugular intrahepatic portosystemic shunt (TIPS) reduces portal hypertension complications. Its impact on hepatocellular carcinoma (HCC) remains unclear. We evaluated 42,843 liver transplant candidates with HCC from the Scientific Registry of Transplant Recipients (2002-2022). 4,484 patients with and without TIPS were propensity score-matched 1:3. Analysing wait-list changes in total tumor volume, HCC count, and alpha-fetoprotein levels, and assessing survival from listing and transplantation; TIPS correlated with a decreased nodule count (-0.24 vs. 0.04, p = 0.028) over a median wait period of 284 days (IQR 195-493) and better overall survival from listing (95.6% vs. 91.5% at 1 year, p < 0.0001). It was not associated with changes in tumor volume (0.28 vs. 0.11 cm³/month, p = 0.58) and AFP (14.37 vs. 20.67 ng/mL, p = 0.42). Post-transplant survival rates (91.8% vs. 91.7% at 1 year, p = 0.25) and HCC recurrence (5.1% vs. 5.9% at 5 years, p = 0.14) were similar, with a median follow-up of 4.98 years (IQR 2.5-8.08). While TIPS was associated with a reduced nodule count and improved waitlist survival, it did not significantly impact HCC growth or aggressiveness. These findings suggest potential benefits of TIPS in HCC management, but further studies need to confirm TIPS safety.
摘要：
经颈静脉肝内门体分流术（TIPS）可减少门静脉高压并发症。其对肝细胞癌（HCC）的影响尚不清楚。我们从移植受体科学注册（2002-2022）评估了42,843例肝癌肝移植候选人。有和没有TIPS的4,484例患者的倾向评分匹配为1：3。分析总肿瘤体积的等待列表变化，HCC计数，甲胎蛋白水平,并评估上市和移植后的存活率；TIPS与结节计数减少相关(-0.24vs.0.04，p=0.028），中位等待期为284天（IQR195-493），并且从列表中获得更好的总体生存率（95.6％vs.一年91.5%，p<0.0001)。它与肿瘤体积的变化无关（0.28vs.0.11厘米/月，p=0.58）和AFP（14.37vs.20.67ng/mL,p=0.42）。移植后存活率（91.8%vs.一年91.7%，p=0.25）和HCC复发（5.1%vs.5年为5.9%，p=0.14)相似，中位随访时间为4.98年（IQR2.5-8.08）。虽然TIPS与减少结节数量和提高候诊者生存率相关，它没有显着影响HCC的生长或侵袭性。这些发现表明TIPS在HCC管理中的潜在益处，但进一步的研究需要确认TIPS的安全性。
