Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.
DHU Hepatinov, Villejuif, France.
Liver Int. 2019 Jan;39(1):136-146. doi: 10.1111/liv.13921. Epub 2018 Jul 30.
BACKGROUND & AIMS: HIV/HCV co-infected patients with hepatocellular carcinoma (HCC) have poorer survival than HCV mono-infected patients. We aimed to evaluate the prognostic factors for survival.
From 2006 to 2013, 55 incident HCCs among HIV+/HCV+ patients, from three ANRS cohorts, were compared with 181 HCCs in HIV-/HCV+ patients from the ANRS Cirvir cohort.
HIV+/HCV+ patients were younger (50 years [IQR: 47-53] vs 62 [54-70], P < 0.001), male (89% vs 63%, P < 0.001) than HIV-/HCV+ patients. At HCC diagnosis, both groups had a majority of non-responders to anti-HCV-therapy, and HIV+/HCV+ patients had more frequently known a previous cirrhosis decompensation (31% vs 14%, P = 0.005). At diagnostic imaging, there were more infiltrative forms of HCC in HIV+/HCV+ group (24% vs 14%, P < 0.001), associated with tumour portal thrombosis in 29%. During a median follow-up period of 11.96 [5.51-27] months since HCC diagnosis, a majority of palliative treatments were decided in HIV+/HCV+ patients (51% vs 19%, P < 0.001). The 1 and 2-year crude survival rates were 61% versus 78% and 47% versus 63%, P = 0.003 respectively. In a Cox model multivariate analysis adjusted for the cohort, age and sex, the most important prognostic factor for survival was the infiltrative form of the tumour (aRR: 8.10 [4.17-15.75], P < 0.001).
The radiological aggressiveness of the tumour is the best prognostic factor associated with poorer survival of HCC in HIV+/HCV+ patients. High α-foetoprotein level and decompensated cirrhosis are other ones. This justifies a particular attention to the detection and the management of small nodules in this high-risk population.
与 HCV 单感染患者相比，合并 HIV/HCV 感染的肝细胞癌 (HCC) 患者的生存率更差。本研究旨在评估影响生存的预后因素。
2006 年至 2013 年，我们比较了来自三个 ANRS 队列的 55 例 HIV+/HCV+患者新诊断的 HCC，与来自 ANRS Cirvir 队列的 181 例 HIV-/HCV+患者的 HCC 进行比较。
HIV+/HCV+患者比 HIV-/HCV+患者更年轻（中位年龄 50 岁 [IQR：47-53] 与 62 岁 [54-70]，P＜0.001），男性（89%与 63%，P＜0.001）比例更高。在 HCC 诊断时，两组均有大多数患者对 HCV 治疗无应答，HIV+/HCV+患者既往更常出现肝硬化失代偿（31%与 14%，P=0.005）。在诊断性影像学检查中，HIV+/HCV+患者的 HCC 侵袭性形式更多见（24%与 14%，P＜0.001），伴有门静脉癌栓形成 29%。在 HCC 诊断后中位随访 11.96 [5.51-27] 个月期间，HIV+/HCV+患者中多数决定姑息治疗（51%与 19%，P＜0.001）。1 年和 2 年的粗生存率分别为 61%与 78%和 47%与 63%，P=0.003。在调整了队列的 Cox 多变量分析中，年龄和性别是生存的最重要预后因素，肿瘤的侵袭性形式是影响生存的最重要预后因素（ARR：8.10 [4.17-15.75]，P＜0.001）。
肿瘤的影像学侵袭性是影响 HIV+/HCV+患者 HCC 生存的最佳预后因素。高甲胎蛋白水平和失代偿性肝硬化也是其他因素。这证明了在高危人群中特别需要注意检测和管理小的结节。
