Division of Gastroenterology, Faculty of Medicine, Cukurova University, Adana, Turkey.
Eur J Gastroenterol Hepatol. 2022 Jul 1;34(7):769-773. doi: 10.1097/MEG.0000000000002341. Epub 2021 Dec 30.
Symptomatic hepatocellular carcinoma (HCC) patients may generally display constitutional symptoms such as abdominal pain, weight loss, anorexia and localized mass, or atypical clinical features of paraneoplastic syndrome (PNS) such as hypercholesterolemia, hypercalcemia, hypoglycemia, erythrocytosis and thrombocytosis. The most common PNS in HCC is hypercholesterolemia, hypercalcemia, hypoglycemia and erythrocytosis. The aim of this study isto evaluate the relationship of PNS in HCC patients.
In this study, the data of 534 patients who were followed up with the diagnosis of HCC between January 2010 and December 2020 in the Gastroenterology clinic were evaluated retrospectively. Clinical data, age, gender, complete blood count of patients with and without PNS, liver biochemistry, alpha-fetoprotein (AFP) level, hepatitis B surface antigen, anti-hepatitis B virus, Child-Pugh score, model for end-stage liver disease score, tumor volume, portal vein thrombosis, liver biopsy histology and radiologic images were taken from the hospital data system and analyzed.
Out of the 534 HCC patients, 120 (22.3%) were PNS-positive patients. There was a significant difference between the ages of PNS-positive and PNS-negative patients, and PNS-positive patients were older (64.60±12.97) (P=0.02). PNS-positive HCC was determined as hypoglycemia 5.8%, hypercalcemia 6.3%, erythrocytosis 3.9%, hypercholesterolemia 2.4% and thrombocytosis 3.9%. AFP level (22908 ± 60 ng/ml) and tumor diameter (>10 cm) were higher in the PNS-positive group. Multivariate analysis showed that stage C according to Child-Pugh score and tumor diameter >10 cm were independent predictors of poor prognosis, whereas PNS erythrocytosis and thrombocytosis were independent predictors of better prognosis.
In PNS-positive HCC patients, hypoglycemia and hypercalcemia were associated with poor prognosis according to Child-Pugh score, whereas erythrocytosis and thrombocytosis were associated with good prognosis.
有症状的肝细胞癌（HCC）患者通常表现为腹痛、体重减轻、食欲不振和局部肿块等全身症状，或副肿瘤综合征（PNS）等非典型临床特征，如高胆固醇血症、高钙血症、低血糖、红细胞增多症和血小板增多症。HCC 最常见的 PNS 是高胆固醇血症、高钙血症、低血糖和红细胞增多症。本研究旨在评估 HCC 患者 PNS 的关系。
本研究回顾性分析了 2010 年 1 月至 2020 年 12 月期间在消化内科就诊并诊断为 HCC 的 534 例患者的临床资料。对有或无 PNS 的患者的临床数据、年龄、性别、全血细胞计数、肝生化、甲胎蛋白（AFP）水平、乙型肝炎表面抗原、抗乙型肝炎病毒、Child-Pugh 评分、终末期肝病模型评分、肿瘤体积、门静脉血栓形成、肝活检组织学和影像学图像进行了评估。这些数据均来自医院数据系统。
534 例 HCC 患者中，120 例（22.3%）为 PNS 阳性患者。PNS 阳性和 PNS 阴性患者的年龄存在显著差异，PNS 阳性患者年龄较大（64.60±12.97）（P=0.02）。PNS 阳性 HCC 被确定为低血糖 5.8%、高钙血症 6.3%、红细胞增多症 3.9%、高胆固醇血症 2.4%和血小板增多症 3.9%。PNS 阳性组 AFP 水平（22908±60ng/ml）和肿瘤直径（>10 cm）较高。多因素分析显示，Child-Pugh 评分 C 期和肿瘤直径>10 cm 是预后不良的独立预测因素，而 PNS 红细胞增多症和血小板增多症是预后良好的独立预测因素。
在 PNS 阳性的 HCC 患者中，根据 Child-Pugh 评分，低血糖和高钙血症与预后不良相关，而红细胞增多症和血小板增多症与预后良好相关。
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