HIV感染患者肝细胞癌的临床表现与预后：一项美加多中心研究
Presentation and outcome of hepatocellular carcinoma in HIV-infected patients: a U.S.-Canadian multicenter study.
作者信息
Bräu Norbert, Fox Rena K, Xiao Peiying, Marks Kristen, Naqvi Zeenat, Taylor Lynn E, Trikha Anita, Sherman Morris, Sulkowski Mark S, Dieterich Douglas T, Rigsby Michael O, Wright Teresa L, Hernandez Maria D, Jain Mamta K, Khatri Gajendra K, Sterling Richard K, Bonacini Maurizio, Martyn Catherine A, Aytaman Ayse, Llovet Josep M, Brown Sheldon T, Bini Edmund J
机构信息
Bronx Veterans Affairs (VA) Medical Center, Infectious Disease Section (111F), 130 West Kingsbridge Road, Bronx, NY 10468, USA.
出版信息
J Hepatol. 2007 Oct;47(4):527-37. doi: 10.1016/j.jhep.2007.06.010. Epub 2007 Jul 19.
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-Clínic-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-Clínic-Liver-Cancer stages C+D (HR, 0.491; p<0.001), AST/ALT >or= 2.00 (HR, 0.597; p=0.001), AFP >or= 400 ng/mL (HR, 0.55, p=0.003), and platelets >or= 100,000/mm3 (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 (<400 copies/mL) than with HIV viremia (6.5 vs. 2.6 months, p=0.013).
CONCLUSIONS
HIV-positive HCC patients are younger and more frequently symptomatic and infected with HCV or HBV than HIV-negative patients. Tumor staging and survival are similar. In untreated patients, undetectable HIV RNA independently predicts better survival.
背景/目的：感染人类免疫缺陷病毒（HIV）的患者现在寿命更长，并且常常出现肝脏疾病并发症，尤其是合并乙型或丙型肝炎病毒感染时。关于肝细胞癌（HCC）患者的数据有限。
方法
对1992年至2005年期间6个中心进行的回顾性分析确定了63例HIV感染的HCC患者。对照组为来自4个地点的226例连续的HIV阴性HCC患者。
结果
HIV阳性患者比对照组年轻（52岁对64岁，p<0.001），更常患有慢性乙型或丙型肝炎（97%对73%，p<0.001），症状更常见（51%对38%，p=0.048），甲胎蛋白水平中位数更高（227对51 ng/ml，p=0.005），但Child-Turcotte-Pugh评分均值相似（7.0对7.5，p=0.05），HCC分期评分相似（巴塞罗那临床肝癌分期C+D期在50%对58%，p=0.24）。HIV/HCV合并感染患者的HCC发展比HCV单一感染患者更快（平均，HCV感染后26年对34年，p=0.002）。HIV阳性患者更常接受有效治疗（48%对31%，p=0.017），但中位生存期相似（6.9个月对7.5个月，p=0.44）。预测生存的独立因素为有症状表现（风险比[HR]，0.437；p<0.001）、任何有效治疗（HR，2.19；p<0.001）、2002年1月1日后诊断（HR，1.52；p=0.010）、巴塞罗那临床肝癌分期C+D期（HR，0.491；p<0.001）、谷草转氨酶/谷丙转氨酶≥2.00（HR，0.597；p=0.001）、甲胎蛋白≥400 ng/mL（HR，0.55，p=0.
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