Presentation and outcome of hepatocellular carcinoma in HIV-infected patients:: A US-Canadian multicenter study
Presentation and outcome of hepatocellular carcinoma in HIV-infected patients:: A US-Canadian multicenter study
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DOI：
10.1016/j.jhep.2007.06.010
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发表时间：
2007-10-01
影响因子：
25.7
通讯作者：
Bini, Edmund J.
中科院分区：
文献类型：
--
作者：
Braeu, Norbert;Fox, Rena K.;Bini, Edmund J.
背景/目的：现在艾滋病毒感染者的寿命更长，而且经常有肝病并发症，特别是B或C型肝炎病毒合并感染。有限的数据可用于那些与hepatocellular carcinoma（HCC）。方法：回顾性分析，从1992年至2005年在6个中心确定了63例HIV感染的HCC患者。对照组为来自四个研究中心的226名连续的HIV阴性HCC患者。HIV阳性患者比对照组年轻（52岁vs. 64岁，p < 0.001），更常见的慢性肝炎B或C（97% vs. 73%，p < 0.001），（51% vs. 38%，p = 0.048），中位甲胎蛋白水平较高（227与51 ng/ml，p = 0.005），但平均Child-Turcotte-Pugh评分相似（7.0 vs. 7.5，p = 0.05）和HCC分期评分（50% vs. 58%，p = 0.24）。HIV/HCV合并感染者的HCC发展速度快于HCV单一感染者（平均感染后26年vs 34年，p = 0.002）。HIV阳性患者更常接受经证实的治疗（48%对31%，p = 0.017），但中位生存期相似（6.9对7.5个月，p = 0.44）。预测生存率的独立因素是症状表现（风险比[HR]，0.437; p < 0.001），任何已证实的治疗（HR，2.19; p < 0.001），2002年1月1日之后诊断（HR，1.52; p = 0.010），维罗纳-诊所-肝癌C + D期（HR，0.491; p < 0.001），AST/ALT >= 2.00（HR，0.597; p = 0.001），AFP >= 400 ng/mL（HR，0.55，p = 0.003），血小板>= 100，000/mm 3（HR，0.651; p = 0.012），但不是HIV血清状态（p = 0.19）。在未接受HCC治疗的HIV感染患者中（n = 33），HIV RNA检测不到的患者中位生存期较长（
Background/Aims: HIV-infected patients now live longer and often have complications of liver disease, especially with hepatitis B or C virus coinfection. Limited data are available on those with hepatocellular carcinoma (HCC).Methods:A retrospective analysis from 1992 to 2005 in 6 centers identified 63 HIV-infected HCC patients. Controls were 226 consecutive HIV-negative HCC patients from four sites.Results: HIV-positive patients were younger than controls (52 vs. 64 years, p < 0.001), more commonly had chronic hepatitis B or C (97% vs. 73%, p < 0.001), were more frequently symptomatic (51% vs. 38%, p = 0.048), had a higher median alfa-fetoprotein level (227 vs. 51 ng/ml, p = 0.005), but a similar mean Child-Turcotte-Pugh score (7.0 vs. 7.5, p = 0.05) and HCC staging score (Barcelona-Clinic-Liver-Cancer stages C + D in 50% vs. 58%, p = 0.24). HCC developed faster in HIV/HCV-coinfected than in HCV-monoinfected patients (mean, 26 vs. 34 years after HCV infection, p = 0.002). HIV-positive patients received proven therapy more often (48% vs. 31%, p = 0.017), but median survival was similar (6.9 vs. 7.5 months, p = 0.44). Independent factors predicting survival were symptomatic presentation (hazard ratio [HR], 0.437; p < 0.001), any proven therapy (HR, 2.19; p < 0.001), diagnosis after 01-Jan-2002 (HR, 1.52; p = 0.010), Barcelona-Clinic-Liver-Cancer stages C + D (HR, 0.491; p < 0.001), AST/ALT >= 2.00 (HR, 0.597; p = 0.001), AFP >= 400 ng/mL (HR, 0.55, p = 0.003), and platelets >= 100,000/mm(3) (HR, 0.651; p = 0.012), but not HIV-serostatus (p = 0.19). In HIV-infected patients without HCC therapy (n = 33), median survival was longer with undetectable HIV RNA (