HIV 感染者与未感染的显微镜下确诊肝细胞癌患者在病理学、分期和治疗方面的差异。
Differences in Pathology, Staging, and Treatment between HIV and Uninfected Patients with Microscopically Confirmed Hepatocellular Carcinoma.
机构信息
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
Cancer Epidemiol Biomarkers Prev. 2020 Jan;29(1):71-78. doi: 10.1158/1055-9965.EPI-19-0503. Epub 2019 Oct 1.
BACKGROUND
The incidence of hepatocellular carcinoma (HCC) is substantially higher among HIV-infected (HIV) than uninfected persons. It remains unclear if HCC in the setting of HIV infection is morphologically distinct or more aggressive.
METHODS
We evaluated differences in tumor pathology in a cohort of HIV and uninfected patients with microscopically confirmed HCC in the Veterans Aging Cohort Study from 2000 to 2015. We reviewed pathology reports and medical records to determine Barcelona Clinic Liver Cancer stage (BCLC), HCC treatment, and survival by HIV status. Multivariable Cox regression was used to determine the hazard ratio [HR; 95% confidence interval (CI)] of death associated with HIV infection after microscopic confirmation.
RESULTS
Among 873 patients with HCC (399 HIV), 140 HIV and 178 uninfected persons underwent liver tissue sampling and had microscopically confirmed HCC. There were no differences in histologic features of the tumor between HIV and uninfected patients, including tumor differentiation (well differentiated, 19% vs. 28%, = 0.16) and lymphovascular invasion (6% vs. 7%, = 0.17) or presence of advanced hepatic fibrosis (40% vs. 39%, = 0.90). There were no differences in BCLC stage ( = 0.06) or treatment ( = 0.29) by HIV status. After adjustment for risk factors, risk of death was higher among HIV-infected than uninfected patients (HR = 1.37; 95% CI, 1.02-1.85).
CONCLUSIONS
We found no differences in HCC tumor characteristics or background hepatic parenchyma by HIV status, yet HIV was associated with poorer survival. Of note, pathology reports often omitted these characteristics.
IMPACT
Systematic evaluation of HCC pathology by HIV status is needed to understand tumor characteristics associated with improved survival.
背景
与未感染 HIV 的人群相比，感染 HIV 的人群中肝细胞癌 (HCC) 的发病率要高得多。目前尚不清楚 HIV 感染背景下的 HCC 在形态上是否存在差异，或者是否更具侵袭性。
方法
我们评估了 2000 年至 2015 年退伍军人老龄化队列研究中 HIV 感染和未感染的显微镜下确诊 HCC 患者队列中肿瘤病理学的差异。我们查阅了病理学报告和病历，以确定巴塞罗那临床肝癌分期 (BCLC)、HCC 治疗和生存情况按 HIV 状态分类。采用多变量 Cox 回归分析确定显微镜确认后 HIV 感染与死亡相关的风险比（HR；95%置信区间[CI]）。
结果
在 873 例 HCC 患者（399 例 HIV）中，140 例 HIV 患者和 178 例未感染患者进行了肝组织取样，并且显微镜下均确诊为 HCC。HIV 患者与未感染患者的肿瘤组织学特征无差异，包括肿瘤分化（高分化，19%比 28%， = 0.16）和血管侵犯（6%比 7%， = 0.17）或存在晚期肝纤维化（40%比 39%， = 0.90）。BCLC 分期（ = 0.06）或治疗（ = 0.29）无差异。在调整了危险因素后，HIV 感染者的死亡风险高于未感染者（HR=1.37；95%CI，1.02-1.85）。
结论
我们发现 HIV 状态与 HCC 肿瘤特征或背景肝实质无差异，但 HIV 与生存率降低有关。值得注意的是，病理报告通常忽略了这些特征。
影响
需要按 HIV 状态系统评估 HCC 病理学，以了解与生存率提高相关的肿瘤特征。
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