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Prevalence and risk factors of hepatocellular carcinoma in Budd–Chiari syndrome: a systematic review

Ren, Weironga,*; Qi, Xingshuna,*; Yang, Zhipinga; Han, Guohonga; Fan, Daiminga,b

European Journal of Gastroenterology & Hepatology: July 2013 - Volume 25 - Issue 7 - p 830–841
doi: 10.1097/MEG.0b013e32835eb8d4
Original Articles: Hepato-cellular Carcinoma
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Objective Budd–Chiari syndrome (BCS) can be incidentally complicated by hepatocellular carcinoma (HCC), thereby decreasing the survival of these patients. Our study aims to systematically review the prevalence and risk factors of HCC in BCS patients.

Methods A PubMed search was performed to identify all original articles that reported the prevalence and risk factors of HCC in BCS patients. Primary items were the prevalence and risk factors of HCC in BCS patients.

Results Of 1487 articles identified, 16 were included in our study. The prevalence of HCC in BCS is 2.0–46.2% in 12 Asian studies, 40.0–51.6% in two African studies, 11.3% in one European study, and 11.1% in one American study. Irrespective of hepatitis as the underlying risk factor of HCC, the pooled prevalence of HCC was 17.6% in BCS patients [95% confidence interval (CI): 10.1–26.7%], 26.5% in inferior vena cava obstruction (95% CI: 14.4–40.7%), and 4.2% in hepatic vein obstruction (95% CI: 1.6–7.8%). As patients with HCC and concomitant hepatitis were excluded, the pooled prevalence of HCC was 15.4% in BCS patients (95% CI: 6.8–26.7%). Heterogeneity among studies was statistically significant in these meta-analyses. The risk factors of HCC in BCS included hepatic venous pressure gradient and female sex in two Asian studies, and male sex, factor V Leiden mutation, and inferior vena cava obstruction in one European study.

Conclusion HCC was frequent in BCS. However, there was a huge variation among studies. Routine surveillance for HCC is warranted in BCS patients. The risk factors of HCC in BCS may vary depending on the geographic origin of the studies.

Supplemental Digital Content is available in the text.

aDepartment of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases

bState Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi’an, China

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.eurojgh.com).

*Weirong Ren and Xingshun Qi contributed equally to the writing of this article.

Correspondence to Guohong Han, MD, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 15 West Changle Road, Xi’an 710032, China Tel: +86 29 84771537; fax: +86 29 82539041; e-mail: guohhan@126.com

Received September 24, 2012

Accepted December 28, 2012

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins