医学
倾向得分匹配
肝性脑病
经颈静脉肝内门体分流术
回顾性队列研究
肝硬化
肝细胞癌
队列
内科学
米兰标准
胃肠病学
门脉高压
外科
肝移植
移植
作者
Junyang Luo,Mingan Li,Chun Wu,Duo Zhu,Haofan Wang,Mingsheng Huang,Zaibo Jiang
标识
DOI:10.1097/meg.0000000000001750
摘要
Objective Transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic therapy (ET) have been recommended to prevent variceal rebleeding due to cirrhotic portal hypertension. However, which one is better for patients with hepatocellular carcinoma (HCC) remains controversial. Hence, we aimed to compare the clinical outcomes of these two treatments for these subpopulation. Methods This retrospective study was approved by the institutional review board. The data of 98 consecutive patients with HCC meeting the Milan criteria (mean age 54.1 years) who had received TIPS placement (34 patients) or ET (64 patients) between June 2010 and December 2017 were reviewed. The clinical outcomes were evaluated and were calculated by the Kaplan–Meier method and compared by using the log-rank test. A matched cohort composed of 34 patients from each group was selected after adjustment with propensity score matching to verify the robustness of the results. Results The median follow-up time was 33.1 months. The rebleeding rate was significantly lower in TIPS group ( P = 0.016). A matched cohort composed of 34 patients from each group after adjustment with propensity score matching showed that TIPS reduced the risk of rebleeding ( P = 0.030) without increasing long-term overt hepatic encephalopathy ( P = 0.151), while there was no significant difference in overall liver transplant-free survival ( P = 0.120). Thereafter, 25 patients in TIPS group (73.5%) and 42 patients in ET group (65.6%) received locoregional therapies for HCC ( P = 0.431). Conclusion TIPS reduced the risk of rebleeding without improving survival. Locoregional therapies can be performed safely to manage HCC after sufficient prevention of variceal rebleeding.
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