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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2024; 16(3): 699-715
Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.699
Clinical profile and outcomes of hepatocellular carcinoma in primary Budd-Chiari syndrome
Ankit Agarwal, Sagnik Biswas, Shekhar Swaroop, Arnav Aggarwal, Ayush Agarwal, Gautam Jain, Anshuman Elhence, Arun Vaidya, Amit Gupte, Ravi Mohanka, Ramesh Kumar, Ashwani Kumar Mishra, Shivanand Gamanagatti, Shashi Bala Paul, Subrat Kumar Acharya, Akash Shukla, Shalimar
Ankit Agarwal, Sagnik Biswas, Shekhar Swaroop, Arnav Aggarwal, Ayush Agarwal, Anshuman Elhence, Subrat Kumar Acharya, Shalimar, Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Gautam Jain, Arun Vaidya, Akash Shukla, Department of Gastroenterology, Seth Gordhandas Sunderdas Medical College and KEM Hospital, Mumbai 400012, Maharashtra, India
Amit Gupte, Department of Gastroenterology, Sir HN Reliance Foundation Hospital, Mumbai 400004, India
Ravi Mohanka, Department of Liver Transplant and HPB, Sir HN Reliance Foundation Hospital, Mumbai 400004, India
Ramesh Kumar, Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
Ashwani Kumar Mishra, Professor of Biostatistics, National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences, New Delhi 110029, India
Shivanand Gamanagatti, Shashi Bala Paul, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Author contributions: Agarwal A and Biswas S designed and conducted the study, acquired the data, performed analysis and interpretation of data, and drafted the manuscript; Swaroop S, Aggarwal A, Agarwal A, Jain G, Vaidya A, Gupte A, Mohanka R, and Kumar R acquired the data and revised the manuscript; Mishra AK undertook the statistical analysis, interpretation of data, and revision of the manuscript; Elhence A, Gamanagatti S, Paul SB, Acharya SK, and Shukla A acquired the data and revised the manuscript; Shalimar conceptualized and designed the study and provided administrative, technical, or material support and study supervision, interpretation of data, critical revision, and final approval of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the All India Institute of Medical Sciences, New Delhi (Approval No. IEC/NP-458/12.12.2014, RP 22-2015).
Informed consent statement: Written informed consent was waived (de-identified data).
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Shalimar, MD, Professor, Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi 110029, Delhi, India. drshalimar@yahoo.com
Received: October 3, 2023
Peer-review started: October 3, 2023
First decision: December 5, 2023
Revised: December 22, 2023
Accepted: January 16, 2024
Article in press: January 16, 2024
Published online: March 15, 2024
Processing time: 160 Days and 17.5 Hours
ARTICLE HIGHLIGHTS
Research background
Hepatocellular carcinoma (HCC) is a cancer with poor survival outcomes. Budd-Chiari syndrome (BCS) is a disease of the liver that leads to cirrhosis and may lead to HCC. Current guidelines are not clear regarding management of patients with both BCS and HCC. In clinical practice there can be barriers to providing treatments that can improve outcomes for those with HCC. Liver transplant or curative surgery are not an option for those diagnosed with advanced disease. Treatment protocols include managing BCS first followed by treating HCC. Locoregional therapies (e.g., transarterial chemoembolization) is feasible in a selected group of patients and improves outcomes.
Research motivation
There is very little data to decide management of HCC in BCS. Therefore, research into this area is needed due to the complexity of treating patients with both HCC and BCS. We hypothesize that treating BCS first followed by treatment of HCC should be one of the strategies to improve outcomes in these patients.
Research objectives
To investigate the magnitude, clinical characteristics, and treatment outcomes in patients with HCC and BCS.
Research methods
We conducted a retrospective cohort study including patients diagnosed with BCS over a span of more than 30 years We used Kaplan-Meir survival curve analysis to calculate the median survival of HCC among BCS patients using the available follow-up of each patient.
Research results
In a study of 904 BCS patients, 35 developed BCS-associated HCC (BCS-HCC). Prevalence stood at 3.8%, with an HCC incidence of 0.36 per 100 person-years. BCS-HCC patients were older, had increased complications, and higher liver enzyme levels compared to BCS alone. Most underwent BCS interventions (74.3%), with 62.8% receiving HCC treatment. Those undergoing interventions exhibited prolonged median survival (3.5 years) as compared to those who did not (3.1 mo).
Research conclusions
We found that HCC is not uncommon in patients with BCS. A significant proportion of them present as advanced disease precluding them from liver transplant or curative surgeries. Improvement in survival was statistically significant in patients receiving treatment for HCC as compared to ones who did not. Locoregional therapies were suitable in these patients and improves outcomes.
Research perspectives
This study, a retrospective analysis of clinical records, observed that locoregional therapies are feasible in patients with HCC due to BCS, consequently leading to improved treatment outcomes. This further validates the role of locoregional therapies in patients with BCS-HCC.
