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Risk of Liver Cirrhosis and Hepatocellular Carcinoma after Fontan Operation: A Need for Surveillance
Liver cirrhosis and hepatocellular carcinoma (HCC) are serious late complications that can occur after the Fontan procedure. This study aimed to investigate the cumulative incidence of cirrhosis and HCC and to identify specific features distinguishing HCC from benign arterial-phase hyperenhancing (A...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408507/ https://www.ncbi.nlm.nih.gov/pubmed/32640555 http://dx.doi.org/10.3390/cancers12071805 |
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author | Yoon, Jun Sik Lee, Dong Ho Cho, Eun Ju Song, Mi Kyoung Choi, Young Hun Kim, Gi Beom Lee, Yun Bin Lee, Jeong-Hoon Yu, Su Jong Kim, Haeryoung Kim, Yoon Jun Yoon, Jung-Hwan Bae, Eun Jung |
author_facet | Yoon, Jun Sik Lee, Dong Ho Cho, Eun Ju Song, Mi Kyoung Choi, Young Hun Kim, Gi Beom Lee, Yun Bin Lee, Jeong-Hoon Yu, Su Jong Kim, Haeryoung Kim, Yoon Jun Yoon, Jung-Hwan Bae, Eun Jung |
author_sort | Yoon, Jun Sik |
collection | PubMed |
description | Liver cirrhosis and hepatocellular carcinoma (HCC) are serious late complications that can occur after the Fontan procedure. This study aimed to investigate the cumulative incidence of cirrhosis and HCC and to identify specific features distinguishing HCC from benign arterial-phase hyperenhancing (APHE) nodules that developed after the Fontan operation. We retrospectively enrolled 313 post-Fontan patients who had been followed for more than 5 years and had undergone ultrasound or computed tomography (CT) of the liver between January 2000 and August 2018. Cirrhosis was diagnosed radiologically. The estimated cumulative incidence rates of cirrhosis at 5, 10, 20, and 30 years after the Fontan operation were 1.3%, 9.2%, 56.6%, and 97.9%, respectively. Multiphasic CT revealed that 18 patients had APHE nodules that were ≥1 cm in size and showed washout in the portal venous phase (PVP)/delayed phase, which met current noninvasive HCC diagnosis criteria. Among them, only seven patients (38.9%, 7/18) were diagnosed with HCC. After cirrhosis developed, the annual incidence of HCC was 1.04%. The appearance of washout in the PVP (p = 0.006), long time elapsed since the initial Fontan operation (p = 0.04), large nodule size (p = 0.03), and elevated serum α-fetoprotein (AFP) level (p < 0.001) were significantly associated with HCC. In conclusion, cirrhosis is a frequent late complication after Fontan operation, especially after 10 years, and HCC is not a rare complication after cirrhosis development. Diagnosis of HCC should not be based solely on the current imaging criteria, and washout on PVP and clinical features might be helpful to differentiate HCC nodules from benign APHE nodules. |
format | Online Article Text |
id | pubmed-7408507 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-74085072020-08-13 Risk of Liver Cirrhosis and Hepatocellular Carcinoma after Fontan Operation: A Need for Surveillance Yoon, Jun Sik Lee, Dong Ho Cho, Eun Ju Song, Mi Kyoung Choi, Young Hun Kim, Gi Beom Lee, Yun Bin Lee, Jeong-Hoon Yu, Su Jong Kim, Haeryoung Kim, Yoon Jun Yoon, Jung-Hwan Bae, Eun Jung Cancers (Basel) Article Liver cirrhosis and hepatocellular carcinoma (HCC) are serious late complications that can occur after the Fontan procedure. This study aimed to investigate the cumulative incidence of cirrhosis and HCC and to identify specific features distinguishing HCC from benign arterial-phase hyperenhancing (APHE) nodules that developed after the Fontan operation. We retrospectively enrolled 313 post-Fontan patients who had been followed for more than 5 years and had undergone ultrasound or computed tomography (CT) of the liver between January 2000 and August 2018. Cirrhosis was diagnosed radiologically. The estimated cumulative incidence rates of cirrhosis at 5, 10, 20, and 30 years after the Fontan operation were 1.3%, 9.2%, 56.6%, and 97.9%, respectively. Multiphasic CT revealed that 18 patients had APHE nodules that were ≥1 cm in size and showed washout in the portal venous phase (PVP)/delayed phase, which met current noninvasive HCC diagnosis criteria. Among them, only seven patients (38.9%, 7/18) were diagnosed with HCC. After cirrhosis developed, the annual incidence of HCC was 1.04%. The appearance of washout in the PVP (p = 0.006), long time elapsed since the initial Fontan operation (p = 0.04), large nodule size (p = 0.03), and elevated serum α-fetoprotein (AFP) level (p < 0.001) were significantly associated with HCC. In conclusion, cirrhosis is a frequent late complication after Fontan operation, especially after 10 years, and HCC is not a rare complication after cirrhosis development. Diagnosis of HCC should not be based solely on the current imaging criteria, and washout on PVP and clinical features might be helpful to differentiate HCC nodules from benign APHE nodules. MDPI 2020-07-06 /pmc/articles/PMC7408507/ /pubmed/32640555 http://dx.doi.org/10.3390/cancers12071805 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Yoon, Jun Sik Lee, Dong Ho Cho, Eun Ju Song, Mi Kyoung Choi, Young Hun Kim, Gi Beom Lee, Yun Bin Lee, Jeong-Hoon Yu, Su Jong Kim, Haeryoung Kim, Yoon Jun Yoon, Jung-Hwan Bae, Eun Jung Risk of Liver Cirrhosis and Hepatocellular Carcinoma after Fontan Operation: A Need for Surveillance |
title | Risk of Liver Cirrhosis and Hepatocellular Carcinoma after Fontan Operation: A Need for Surveillance |
title_full | Risk of Liver Cirrhosis and Hepatocellular Carcinoma after Fontan Operation: A Need for Surveillance |
title_fullStr | Risk of Liver Cirrhosis and Hepatocellular Carcinoma after Fontan Operation: A Need for Surveillance |
title_full_unstemmed | Risk of Liver Cirrhosis and Hepatocellular Carcinoma after Fontan Operation: A Need for Surveillance |
title_short | Risk of Liver Cirrhosis and Hepatocellular Carcinoma after Fontan Operation: A Need for Surveillance |
title_sort | risk of liver cirrhosis and hepatocellular carcinoma after fontan operation: a need for surveillance |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408507/ https://www.ncbi.nlm.nih.gov/pubmed/32640555 http://dx.doi.org/10.3390/cancers12071805 |
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