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

doi:10.4251/wjgo.v16.i3.699

Clinical profile and outcomes of hepatocellular carcinoma in primary Budd-Chiari syndrome

World J Gastrointest Oncol. 2024 Mar 15;16(3):699-715. doi: 10.4251/wjgo.v16.i3.699.

Authors

Ankit Agarwal¹, Sagnik Biswas¹, Shekhar Swaroop¹, Arnav Aggarwal¹, Ayush Agarwal¹, Gautam Jain², Anshuman Elhence¹, Arun Vaidya², Amit Gupte³, Ravi Mohanka⁴, Ramesh Kumar⁵, Ashwani Kumar Mishra⁶, Shivanand Gamanagatti⁷, Shashi Bala Paul⁷, Subrat Kumar Acharya¹, Akash Shukla², Shalimar⁸

Affiliations

¹ Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India.
² Department of Gastroenterology, Seth Gordhandas Sunderdas Medical College and KEM Hospital, Mumbai 400012, Maharashtra, India.
³ Department of Gastroenterology, Sir HN Reliance Foundation Hospital, Mumbai 400004, India.
⁴ Department of Liver Transplant and HPB, Sir HN Reliance Foundation Hospital, Mumbai 400004, India.
⁵ Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India.
⁶ Professor of Biostatistics, National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences, New Delhi 110029, India.
⁷ Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India.
⁸ Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India. drshalimar@yahoo.com.

Abstract

Background: There is scant literature on hepatocellular carcinoma (HCC) in patients with Budd-Chiari syndrome (BCS).

Aim: To assess the magnitude, clinical characteristics, feasibility, and outcomes of treatment in BCS-HCC.

Methods: A total of 904 BCS patients from New Delhi, India and 1140 from Mumbai, India were included. The prevalence and incidence of HCC were determined, and among patients with BCS-HCC, the viability and outcomes of interventional therapy were evaluated.

Results: In the New Delhi cohort of 35 BCS-HCC patients, 18 had HCC at index presentation (prevalence 1.99%), and 17 developed HCC over a follow-up of 4601 person-years, [incidence 0.36 (0.22-0.57) per 100 person-years]. BCS-HCC patients were older when compared to patients with BCS alone (P = 0.001) and had a higher proportion of inferior vena cava block, cirrhosis, and long-segment vascular obstruction. The median alpha-fetoprotein level was higher in patients with BCS-HCC at first presentation than those who developed HCC at follow-up (13029 ng/mL vs 500 ng/mL, P = 0.01). Of the 35 BCS-HCC, 26 (74.3%) underwent radiological interventions for BCS, and 22 (62.8%) patients underwent treatment for HCC [transarterial chemoembolization in 18 (81.8%), oral tyrosine kinase inhibitor in 3 (13.6%), and transarterial radioembolization in 1 (4.5%)]. The median survival among patients who underwent interventions for HCC compared with those who did not was 3.5 years vs 3.1 mo (P = 0.0001). In contrast to the New Delhi cohort, the Mumbai cohort of BCS-HCC patients were predominantly males, presented with a more advanced HCC [Barcelona Clinic Liver Cancer C and D], and 2 patients underwent liver transplantation.

Conclusion: HCC is not uncommon in patients with BCS. Radiological interventions and liver transplantation are feasible in select primary BCS-HCC patients and may improve outcomes.

Keywords: Budd chiari syndrome; Cancer; Cirrhosis; Hepatic venous outflow tract obstruction; Liver; Thrombosis; Transarterial chemoembolization; Varices.