伴有和不伴有人类免疫缺陷病毒感染的肝细胞癌患者的临床表现、治疗和临床结局。
Presentation, treatment, and clinical outcomes of patients with hepatocellular carcinoma, with and without human immunodeficiency virus infection.
机构信息
Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
出版信息
Clin Gastroenterol Hepatol. 2012 Nov;10(11):1284-90. doi: 10.1016/j.cgh.2012.08.010. Epub 2012 Aug 16.
BACKGROUND & AIMS: Liver-related complications such as hepatocellular carcinoma (HCC) are a major cause of morbidity and mortality in individuals infected with human immunodeficiency virus (HIV), particularly among those also infected with hepatitis B or hepatitis C viruses. There is a lack of consensus regarding the clinical presentation, treatment options, and outcomes in HIV-infected patients with HCC. We compared the clinical presentation, treatment, and survival of patients with HCC, with and without HIV infection.
METHODS
We conducted a retrospective cohort study of cirrhotic patients diagnosed with HCC at a large safety-net hospital between January 2005 and December 2010. Patients without known HIV serologic status were excluded. Demographic features, tumor characteristics, treatment regimens, and survival were compared between patients (n = 26) with and without HIV infection (n = 164). Survival curves were generated by using Kaplan-Meier plots and compared by using the log-rank test.
RESULTS
A higher percentage of HIV-infected patients presented with compensated liver disease (Child-Turcotte-Pugh stage A) than those without HIV infection (62% vs 32%, respectively; P = .01), as well as those with early-stage tumors (Barcelona Clinic Liver Cancer stage A, 39% vs 17%, respectively; P = .04 and Okuda stage I, 50% vs 21%, respectively; P < .01). HIV-infected patients were more likely to be cured of HCC than uninfected patients (27% vs 4%, respectively; P = .01), but median overall survival times were similar between groups (9.6 vs 5.2 months, respectively; P = .85). The 1-year rates of survival for HIV-infected and uninfected patients were 40% and 38%, respectively.
CONCLUSIONS
HIV-infected patients present with earlier-stage HCC and more preserved liver function than uninfected patients, resulting in more curative treatment options. Despite this difference, overall survival was similar between patients with HCC with and without HIV infection.
背景与目的
肝相关并发症，如肝细胞癌（HCC），是感染人类免疫缺陷病毒（HIV）个体发病和死亡的主要原因，尤其是在同时感染乙型肝炎或丙型肝炎病毒的个体中。HIV 感染合并 HCC 的患者在临床表现、治疗选择和结局方面缺乏共识。我们比较了 HIV 感染合并 HCC 与不合并 HIV 感染的患者的临床表现、治疗和生存情况。
方法
我们对 2005 年 1 月至 2010 年 12 月在一家大型保障医疗服务医院确诊为 HCC 的肝硬化患者进行了回顾性队列研究。排除了未明确 HIV 血清学状态的患者。比较了有（n = 26）和无（n = 164）HIV 感染的患者的人口统计学特征、肿瘤特征、治疗方案和生存情况。采用 Kaplan-Meier 曲线生成生存曲线，并采用对数秩检验进行比较。
结果
与无 HIV 感染的患者相比，HIV 感染的患者更可能处于代偿性肝病（Child-Turcotte-Pugh 分期 A）（62%比 32%，P =.01）和早期肿瘤（巴塞罗那临床肝癌分期 A，39%比 17%，P =.04 和 Okuda 分期 I，50%比 21%，P <.01）。与未感染患者相比，HIV 感染的患者 HCC 治愈率更高（27%比 4%，P =.01），但两组的中位总生存时间相似（9.6 个月比 5.2 个月，P =.85）。HIV 感染和未感染患者的 1 年生存率分别为 40%和 38%。
结论
与未感染患者相比，HIV 感染的患者 HCC 分期更早，肝功能保存更好，从而获得更多的根治性治疗选择。尽管存在这种差异，但 HIV 感染合并 HCC 与不合并 HIV 感染的患者的总生存情况相似。
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