Impact of transjugular intrahepatic portosystemic shunt on hepatocellular carcinoma: A prospective cohort of liver transplant candidates analysis

Transjugular intrahepatic portosystemic shunt (TIPS) is used to mitigate the side effects of portal hypertension. Its impact on hepatocellular carcinoma (HCC) remains unclear.
We conducted an analysis of 43,734 liver transplant candidates with HCC from the prospective Scientific Registry of Transplant Recipients (SRTR) database between 1985-2022. A total 7,404 patients with and without TIPS were propensity score matched 1:3. We assessed wait-list changes in total tumor volume, number of HCC , and alpha-fetoprotein levels. We examined survival rates from time of listing and post-transplantation, as well as the incidence of HCC recurrence post-transplantation.
Before matching, patients with TIPS exhibited poorer liver function and less advanced HCCs compared to patients without TIPS. After matching, TIPS was associated with a decrease in the number of HCC nodules (-0.24 vs 0.11, p = 0.008) over a median waiting period of 225 days (IQR 94; 441) and a better overall survival rate from listing (93.0% vs 89.1% at one year, p = 0.0003). TIPS was not associated with altered changes in waitlist tumor volume (0.26 vs -0.07 cm3/month, p = 0.26) and AFP (14.62 vs 12.67 ng/mL, p = 0.79) compared to the non-TIPS group. Both post-transplant survival rates (91.8% vs 91.7% at one year, p = 0.25) and incidence of HCC recurrence (5.2% vs 5.4% at 5 years, p = 0.73) were similar between groups with a median follow-up duration of 5.6 years (IQR 2.7; 9.6).
TIPS is associated with improved waitlist survival and a reduction in the number of HCC , potentially due to a better efficacy in HCC treatment. However, TIPS did not have a measurable impact on HCC growth or aggressiveness.

经颈静脉肝内门体分流术（Transjugular intrahepatic portosystemic shunt, TIPS）用于缓解门静脉高压症的不良反应，但其对肝细胞癌（hepatocellular carcinoma, HCC）的影响仍不明确。
本研究从1985年至2022年的美国器官移植受者科学登记库（Scientific Registry of Transplant Recipients, SRTR）前瞻性数据库中，纳入了43734例合并HCC的肝移植候选者进行分析。最终按照1:3的比例对接受与未接受TIPS治疗的7404例患者进行倾向得分匹配。本研究评估了等候移植期间的总肿瘤体积、HCC结节数量及甲胎蛋白（alpha-fetoprotein, AFP）水平的变化；分析了从列入等候移植名单起至移植后的生存率，以及移植后HCC复发率。
匹配前，接受TIPS治疗的患者肝功能较差，但HCC分期较未接受TIPS治疗的患者更低。匹配后，在中位等候期225天（四分位数间距IQR 94；441）内，TIPS治疗组的HCC结节数量较对照组有所减少（-0.24 vs 0.11，P=0.008），且列入等候移植名单后的总生存率更优（1年总生存率：93.0% vs 89.1%，P=0.0003）。与未接受TIPS治疗的对照组相比，TIPS治疗组患者等候移植期间的肿瘤体积变化（0.26 vs -0.07 cm³/月，P=0.26）及AFP水平变化（14.62 vs 12.67 ng/mL，P=0.79）均无显著差异。两组患者的中位随访时长为5.6年（IQR 2.7；9.6），移植后1年生存率（91.8% vs 91.7%，P=0.25）及5年HCC复发率（5.2% vs 5.4%，P=0.73）均无显著差异。
TIPS与等候移植期间生存率提升及HCC结节数量减少相关，这可能与其对HCC的治疗效果更优有关。但TIPS并未对HCC的生长或侵袭性产生可观测的影响。