Division of Gastroenterology und Hepatology, Department of Medicine III, Medical University of Vienna, Vienna; Liver Cancer (HCC) Study Group Vienna, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna; 3(rd) Medical Department (Haematology & Oncology), Hanusch-Krankenhaus, Vienna, Austria.
Division of Gastroenterology und Hepatology, Department of Medicine III, Medical University of Vienna, Vienna; Liver Cancer (HCC) Study Group Vienna, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna.
ESMO Open. 2024 Jun;9(6):103593. doi: 10.1016/j.esmoop.2024.103593. Epub 2024 Jun 7.
Anaemia is frequent in patients with cancer and/or liver cirrhosis and is associated with impaired quality of life. Here, we investigated the impact of anaemia on overall survival (OS) and clinical characteristics in patients with hepatocellular carcinoma (HCC).
HCC patients treated between 1992 and 2018 at the Medical University of Vienna were retrospectively analysed. Anaemia was defined as haemoglobin level <13 g/dl in men and <12 g/dl in women.
Of 1262 assessable patients, 555 (44.0%) had anaemia. The main aetiologies of HCC were alcohol-related liver disease (n = 502; 39.8%) and chronic hepatitis C (n = 375; 29.7%). Anaemia was significantly associated with impaired liver function, portal hypertension, more advanced Barcelona Clinic Liver Cancer stage and elevated C-reactive protein (CRP). In univariable analysis, anaemia was significantly associated with shorter median OS [9.5 months, 95% confidence interval (95% CI) 7.3-11.6 months] versus patients without anaemia (21.5 months, 95% CI 18.3-24.7 months) (P < 0.001). In multivariable analysis adjusted for age, Model for End-stage Liver Disease, number of tumour nodules, size of the largest nodule, macrovascular invasion, extrahepatic spread, first treatment line, alpha-fetoprotein and CRP, anaemia remained an independent predictor of mortality (adjusted hazard ratio 1.23, 95% CI 1.06-1.43, P = 0.006).
Anaemia was significantly associated with mortality in HCC patients, independent of established liver- and tumour-related prognostic factors. Whether adequate management of anaemia can improve outcome of HCC patients needs further evaluation.
贫血在癌症和/或肝硬化患者中很常见，与生活质量受损有关。在这里，我们研究了贫血对肝细胞癌 (HCC) 患者总生存期 (OS) 和临床特征的影响。
回顾性分析了维也纳医科大学 1992 年至 2018 年期间治疗的 HCC 患者。贫血定义为男性血红蛋白水平<13 g/dl，女性血红蛋白水平<12 g/dl。
在 1262 例可评估患者中，555 例（44.0%）有贫血。HCC 的主要病因是酒精性肝病（n=502；39.8%）和慢性丙型肝炎（n=375；29.7%）。贫血与肝功能受损、门静脉高压、巴塞罗那临床肝癌分期更高和 C 反应蛋白 (CRP) 升高显著相关。单变量分析显示，贫血与中位 OS 缩短显著相关[9.5 个月，95%置信区间（95%CI）7.3-11.6 个月]，而无贫血患者的中位 OS 为 21.5 个月（95%CI 18.3-24.7 个月）（P<0.001）。多变量分析调整年龄、终末期肝病模型、肿瘤结节数量、最大结节大小、大血管侵犯、肝外扩散、一线治疗、甲胎蛋白和 CRP 后，贫血仍然是死亡率的独立预测因素（调整后的危险比 1.23，95%CI 1.06-1.43，P=0.006）。
贫血与 HCC 患者的死亡率显著相关，独立于已建立的肝脏和肿瘤相关预后因素。贫血的适当管理是否能改善 HCC 患者的预后需要进一步评估。
