Treatment and outcomes of hepatocellular carcinoma in patients with Sickle cell disease: a population-based study in the U.S.
Treatment and outcomes of hepatocellular carcinoma in patients with Sickle cell disease: a population-based study in the U.S.
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DOI：
10.1016/j.hpb.2021.06.420
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Emamaullee J
中科院分区：
文献类型：
--
作者：
Barbetta A;Goldbeck C;Lim A;Martin SP;Kahn JA;Sheikh MR;Emamaullee J
镰状细胞病(SCD)是一种罕见的血红蛋白疾病，可导致慢性肝病和肝硬变。SCD患者发生血液系统恶性肿瘤的风险增加，但该人群中肝细胞癌(HCC)的患病率尚不清楚。在这里，SCD与肝细胞癌的关联被使用注册数据进行了检验。查询了SEER-Medicare数据库，以确定2000至2015年间被诊断为肝癌的患者，并进一步按SCD状态进行分层。进行倾向匹配以检查癌症相关的存活率和治疗结果。总共确定了56,934名肝细胞癌患者，包括81名SCD患者。SCD患者合并肝硬变的比例较高[48.1%(39/81)vs 23.5%(13,377/56,853)，p<；0.01]但肿瘤体积较小[<；5 cm：51.9%(42/81)vs 38.5%(21,898/56,853)，p=0.01]。经倾向匹配后，SCD与减数生存期无关(AHR 0.73，95%CI 0.52~1.01)。当按治疗分层时，与非SCD患者相比，SCD患者的结果与化疗(p=0.65)、TACE/TARE(p=0.35)、切除(p=0.15)和移植(p=0.67)相同。这项研究证实，SCD患者的一部分将发展为肝细胞癌。重要的是，肝细胞癌的治疗选择不应该受到先前存在的SCD的限制，与非SCD患者相比，应该可以预期类似的存活率。
Sickle cell disease (SCD) is a rare hemoglobinopathy which can result in chronic liver disease and cirrhosis. Patients with SCD have an increased risk of hematologic malignancy, but the prevalence of hepatocellular carcinoma (HCC) in this population is unknown. Herein, the association of SCD with HCC was examined using registry data. The SEER-Medicare database was queried to identify patients diagnosed with HCC between 2000 and 2015, and further stratified by SCD status. Propensity matching was performed to examine cancer-related survival and treatment outcomes. Overall 56,934 patients with HCC were identified, including 81 patients with SCD. Patients with SCD more frequently had cirrhosis [48.1% (39/81) vs 23.5% (13,377/56,853), p<0.01] yet presented with smaller tumors [<5 cm: 51.9% (42/81) vs 38.5% (21,898/56,853), p=0.01]. After propensity matching, SCD was not associated with attenuated survival (aHR 0.73 95%CI 0.52-1.01). When stratified by treatment, patients with SCD had equivalent outcomes to chemotherapy (p=0.65), TACE/TARE (p=0.35), resection (p=0.15) and transplantation (p=0.67) when compared to non-SCD patients. This study confirms that a subset of patients with SCD will develop HCC. Importantly, therapeutic options for HCC should not be limited by pre-existing SCD, and similar survival should be expected when compared to non-SCD patients.
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