Hepatitis C-positive Black patients develop hepatocellular carcinoma at earlier stages of liver disease and present with a more aggressive phenotype.
Hepatitis C-positive Black patients develop hepatocellular carcinoma at earlier stages of liver disease and present with a more aggressive phenotype.
复制标题
DOI：
10.1002/cncr.33377
复制
发表时间：
2021-05-01
期刊：
影响因子：
6.2
通讯作者：
Sarpel U
中科院分区：
文献类型：
--
作者：
Shaltiel T;Zheng S;Siderides C;Gleeson EM;Carr J;Pletcher ER;Cohen NA;Golas BJ;Magge DR;Labow DM;Branch AD;Sarpel U
在美国，诊断为肝细胞癌（HCC）后，黑人患者的死亡率高于其他种族群体的患者。我们的目的是通过分析有丙型肝炎病毒（HCV）感染史的HCC患者的肝脏和肿瘤特征来阐明导致这种差异的因素。回顾性审查了2003-2018年我们机构的HCV/HCC患者记录。种族/民族是自我确定的。比较了黑人和非黑人队列之间的影像学、实验室和病理学特征。在1195例HCC患者中，390例被确定为黑人。在HCC诊断时，黑人患者具有更好的肝功能，如通过Child-Pugh评分、终末期肝病模型评分、非肿瘤组织的组织学和纤维化-4（FIB-4）评分所测量的（所有p< 0.05）。31%的黑人患者的FIB-4评分<3.25。此外，黑人患者的早期HCC（20.2% vs. 32.3%，p<0.05）;较大的肿瘤[中位数，四分位距（IQR），3.5（2.2-6.2）cm vs. 3.1（2.1-5.1）cm，p<0.01];多发性肿瘤更多[中位数，IQR，1（1-3）vs. 1（1-2），p=0.03];低分化肿瘤更多（30.3% vs.20.5%，p<0.05）;和更多的微血管侵犯（67.2% vs.56.5%，p<0.05）。暴露于HCV的黑人患者比其他种族群体的成员在肝脏疾病的早期发展为HCC。近三分之一的人不符合使用常见FIB-4肝硬化阈值进行HCC筛查的资格。实践指南，强调肝细胞癌监测的丙型肝炎患者可能需要修订，以更包容的黑人患者。此外，黑人患者的肿瘤具有更差的预后特征;需要分子研究来表征其生物学特性。
In the United States, mortality after a diagnosis of hepatocellular carcinoma (HCC) is higher in patients who are Black than in patients of other racial groups. We aimed to clarify factors contributing to this disparity by analyzing liver and tumor characteristics in patients with HCC and a history of hepatitis C virus (HCV) infection. Records of HCV/HCC patients at our institution, 2003–2018, were reviewed retrospectively. Race/ethnicity was self-identified. Imaging, laboratory, and pathological features were compared between Black and non-Black cohorts. Among 1195 individuals with HCC, 390 identified as Black. At HCC diagnosis, Black patients had better liver function, as measured by Child-Pugh score, model of end stage liver disease score, histology of non-tumor tissue, and fibrosis-4 (FIB-4) score (all p< 0.05). FIB-4 scores were <3.25 in 31% of Black patients. In addition, Black patients had less early stage HCC (20.2% vs. 32.3%, p<0.05); larger tumors [median, interquartile range (IQR), 3.5 (2.2–6.2) cm vs. 3.1 (2.1–5.1) cm, p<0.01]; more multiple tumors [median, IQR, 1 (1–3) vs. 1 (1–2), p=0.03]; more poorly differentiated tumors (30.3% vs. 20.5%, p<0.05); and more microvascular invasion (67.2% vs. 56.5%, p<0.05). Black patients with HCV exposure develop HCC at earlier stages of liver disease than members of other racial groups. Nearly one-third would not qualify for HCC screening using the common FIB-4 cirrhosis threshold. Practice guidelines which stress HCC surveillance for cirrhotic HCV patients may need to be revised to be more inclusive for Black patients. In addition, tumors in Black patients carry worse prognostic features; molecular studies are needed to characterize their biological properties.
登录
查看更多内容
影响因子：
9.8
作者：
Altekruse, Sean F.;Henley, S. Jane;Cucinelli, James E.;McGlynn, Katherine A.
通讯作者：
McGlynn, Katherine A.
影响因子：
13.5
作者：
Bedossa, P;Poynard, T
通讯作者：
Poynard, T
影响因子：
25.7
作者：
Ditah, Ivo;Ditah, Fausta;Charlton, Michael
通讯作者：
Charlton, Michael
影响因子：
45.3
作者：
Altekruse, Sean F.;McGlynn, Katherine A.;Reichman, Marsha E.
通讯作者：
Reichman, Marsha E.
影响因子：
13.5
作者：
Jonas, S;Bechstein, WO;Neuhaus, P
通讯作者：
Neuhaus, P