The effect of TIPS on the development of hepatocellular carcinoma in patients with cirrhosis: a meta-analysis

BACKGROUND: Liver cirrhosis is a leading cause of global liver-related morbidity and mortality, with hepatocellular carcinoma (HCC) being the most common and fatal complication. Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive treatment for ascites and gastrointestinal bleeding in patients with cirrhosis. Whether transjugular intrahepatic portalsystemic shunt (TIPS) increases the incidence of hepatocellular carcinoma (HCC) in patients with cirrhosis remains controversial. This study aimed to explore the association between TIPS and the development of HCC. METHODS: We systematically researched PubMed, Embase, Cochrane Library, and Web of Science databases from their inception until March 7, 2023, to identify eligible studies. The incidence of HCC was extracted and analyzed using a random-effects in RevMan. The primary outcome was the cumulative incidence of HCC, and secondary outcomes included subgroup HCC risk by etiology, stent type, follow-up duration, and overall survival. This study was registered with PROSPERO (CRD42023442262). RESULTS: Ten studies comprising 2753 patients were included. Among the 1070 patients who received TIPS, 11.31% (121/1070 ) developed HCC, compared with 8.85% (149/1683) developed HCC (8.85%) in 1683 non-TIPS patients. TIPS did not increase the incidence of HCC [OR = 1.16, 95%CI (0.76,1.77), P = 0.51, I²=50%]. We then performed the analysis according to etiology and stent type. In studies primarily focused on alcoholic liver disease, TIPS did not increase the incidence of HCC [OR = 1.07 95% CI (0.61,1.88), P = 0.82, I²=67%]. Comparable results were observed in studies predominantly using bare stents [OR = 1.52, 95% CI (0.98,2.37), P = 0.06, I²=12%]. Furthermore, TIPS did not increase the cumulative incidence of cancer in 1 year [OR = 0.73 95%CI (0.20,2.69), P = 0.63, I²=74%] and 5 years [OR = 0.99 95% CI (0.52,1.87), P = 0.96], nor did it affect the survival rate [OR = 1.22,95% CI (0.65,2.32), P = 0.53, I²=44%]. CONCLUSIONS: TIPS is not associated with an increased risk of HCC development in cirrhosis patients. Clinicians can safely select TIPS as a treatment option for cirrhotic patients with portal hypertension, without excessive concern about an elevated risk of HCC associated with the procedure.