Clinicopathological features and prognosis of Budd-Chiari syndrome associated with hepatocellular carcinoma

Abstract

Objective To analyze the clinicopathological features and prognosis of Budd-Chiari syndrome (BCS) associated with hepatocellular carcinoma (HCC). Methods The clinical data of 33 patients with HCC complicated by BCS were retrospectively analyzed. All the patients underwent sequential percutaneous transluminal angioplasty to relief the obstruction of the inferior vena cava and then hepatic resection for HCC. There were 16 of these patients (48.5%) who underwent postoperative adjuvant TACE. For comparison, 110 patients with HBsAg+ HCC were randomly selected, and 52 of these patients (47.3%) underwent postoperative adjuvant TACE. The clinicopathological, operative outcomes, disease-free survival and overall survival rates between these 2 groups of patients were compared. Result There were no significant differences in gender, age, Child Pugh, AFP and tumor size. However, patients with BCS-associated HCC had significantly higher incidences of solitary tumors, marginal or exogenous growths, poor degrees of tumour differentiation but a lower rate of portal vein invasion. They also had significantly less intraoperative blood loss [(432.3±125.8)ml vs (565.2±143.2)ml, P<0.05], shorter operation time [(132.8±25.5)min vs (173.7±32.3)min, P<0.05] and shorter vascular clamping time [(15.3±3.6)min vs (21.9±7.4)min, P<0.05] when compared with patients with HBV associated HCC. The 1-, 3-, 5-year overall survival rates were 93.1%, 74.1%, 55.2%, respectively, for patients with BCS-associated HCC and 82.6%, 45.9%, 17.3%, respectively, for patients with HBV-associated HCC. The corresponding 1-, 3-, 5-year disease-free survival rates were 86.2%, 51.7%, 0, respectively, versus 57.1%, 10.2%, 0, respectively. The differences in overall and disease-free survival rates between the two groups were significant (P<0.05). Conclusions BCS-associated HCC had more favorable biological behavior and prognosis than HBV-associated HCC. Sequential treatment with percutaneous transluminal angioplasty and hepatic resection could be carried out effectively and safely in these patients. Key words: Budd-Chiari syndrome; Hepatocellular carcinoma; Angioplasty; Hepatectomy; Prognosis