Hepatology

Hepatocellular carcinoma in Budd–Chiari syndrome: characteristics and risk factors

R Moucari¹, P-E Rautou¹, D Cazals-Hatem², A Geara³, C Bureau⁴, Y Consigny¹, C Francoz¹, M-H Denninger⁵, V Vilgrain³, J Belghiti⁶, F Durand¹, D Valla¹, A Plessier¹

¹ AP-HP, Hôpital Beaujon, Service d’Hépatologie, Clichy, France
² AP-HP, Hôpital Beaujon, Service d’Anatomie Pathologique, Clichy, France
³ AP-HP, Hôpital Beaujon, Service d’Imagerie Médicale, Clichy, France
⁴ CHU de Purpan, Service d’Hépato Gastroentérologie, Toulouse, France
⁵ AP-HP, Hôpital Beaujon, Service d’Hématologie, Clichy, France
⁶ AP-HP, Hôpital Beaujon, Service de Chirurgie Digestive, Clichy, France

Dr D Valla, AP-HP, Hôpital Beaujon, Service d’Hépatologie, Clichy, France; dominique.valla{at}bjn.aphp.fr

Background and aim: To analyse the characteristics of and the factors associated with the development of hepatocellular carcinoma (HCC) in patients with Budd–Chiari syndrome (BCS).

Patients and methods: 97 consecutive patients with BCS and a follow-up 1 year were evaluated retrospectively. Liver nodules were evaluated using serum -fetoprotein (AFP) level and imaging features (CT/MRI). Biopsy of nodules was obtained when one of the following criteria was met: number 3, diameter 3 cm, heterogeneity, washout on portal venous phase, increase in size on surveillance, or increase in AFP level.

Results: Patients were mainly Caucasian (69%) and female (66%). Mean age at the diagnosis of BCS was 35.8 (SE 1.2 years), and median follow-up 5 years (1–20 years). The inferior vena cava (IVC) was obstructed in 13 patients. Liver nodules were found in 43 patients, 11 of whom had HCC. Cumulative incidence of HCC during follow-up was 4%. Liver parenchyma adjacent to HCC showed cirrhosis in nine patients. HCC was associated with male sex (72.7% v 29.0%, p = 0.007); factor V Leiden (54.5% v 17.5%, p = 0.01); and IVC obstruction (81.8% v 4.6%, p<0.001). Increased levels of serum AFP were highly accurate in distinguishing HCC from benign nodules: PPV = 100% and NPV = 91% for a cut-off level of 15 ng/ml.

Conclusion: The incidence of HCC in this large cohort of BCS patients was similar to that reported for other chronic liver diseases. IVC obstruction was a major predictor for HCC development. Serum AFP appears to have a higher utility for HCC screening in patients with BCS than with other liver diseases.

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