Characteristics and Prognosis of Hepatocellular Carcinoma in Multi-Transfused Patients with β-Thalassemia. Experience of a Single Tertiary Center.
Cirrhosis
Hemosiderosis
Hepatocellular carcinoma (HCC)
Thalassemia major (TM)
Viral hepatitis
Journal
Mediterranean journal of hematology and infectious diseases
ISSN: 2035-3006
Titre abrégé: Mediterr J Hematol Infect Dis
Pays: Italy
ID NLM: 101530512
Informations de publication
Date de publication:
2020
2020
Historique:
received:
09
09
2019
accepted:
04
02
2020
entrez:
18
3
2020
pubmed:
18
3
2020
medline:
18
3
2020
Statut:
epublish
Résumé
The incidence of hepatocellular carcinoma (HCC) in patients with transfusion dependent thalassemia (TDT) has been increasing, where viral hepatitis and iron overload are the two established HCC risk factors. The aim of this study was to investigate the etiological factors of HCC development and to evaluate the possible factors associated with survival in our cohort of TDT patients with HCC. Records of patients with TDT diagnosed with HCC from 2008 to 2018 were reviewed. Liver iron concentration (LIC) has been assessed by the signal-intensity-ratio MRI. The diagnosis of HCC was made by a 3-phase contrast magnetic resonance imaging (MRI) and patients were staged and treated for HCC according to Barcelona Clinic Liver Cancer (BCLC) grading system. Forty-two TDT patients with HCC have been included. Most of them (78.5%) were anti-HCV positive, 59.5% HCV-RNA positive, and 16.5% had serological markers of resolved HBV infection. Patients with HCV infection have been treated successfully with either Peg-IFNa±Ribavirin or with the new direct antivirals (DAAs). At the time of HCC diagnosis, all patients with chronic HCV infection were HCV-RNA negative, 78.5% had underlying cirrhosis, and the vast majority (98%) had average or mild elevated LIC values. According to the BCLC system, patients were classified as 0-A: 28.5%, B: 57% and C-D: 14.5%. HCC has been treated with loco-regional treatment in 78.5% of our patients, while the rest have received sorafenib. Twenty-eight patients (66.5%) died due to HCC with a median survival time of 6 months (range: 2-60). Using the Cox proportional hazard model, the only factors associated with poor survival were BCLC stages C and D. In conclusion, BCLC staging is the main prognostic factor of survival in patients with TDT who develop HCC.
Sections du résumé
BACKGROUND/AIM
OBJECTIVE
The incidence of hepatocellular carcinoma (HCC) in patients with transfusion dependent thalassemia (TDT) has been increasing, where viral hepatitis and iron overload are the two established HCC risk factors. The aim of this study was to investigate the etiological factors of HCC development and to evaluate the possible factors associated with survival in our cohort of TDT patients with HCC.
METHODS
METHODS
Records of patients with TDT diagnosed with HCC from 2008 to 2018 were reviewed. Liver iron concentration (LIC) has been assessed by the signal-intensity-ratio MRI. The diagnosis of HCC was made by a 3-phase contrast magnetic resonance imaging (MRI) and patients were staged and treated for HCC according to Barcelona Clinic Liver Cancer (BCLC) grading system.
RESULTS
RESULTS
Forty-two TDT patients with HCC have been included. Most of them (78.5%) were anti-HCV positive, 59.5% HCV-RNA positive, and 16.5% had serological markers of resolved HBV infection. Patients with HCV infection have been treated successfully with either Peg-IFNa±Ribavirin or with the new direct antivirals (DAAs). At the time of HCC diagnosis, all patients with chronic HCV infection were HCV-RNA negative, 78.5% had underlying cirrhosis, and the vast majority (98%) had average or mild elevated LIC values. According to the BCLC system, patients were classified as 0-A: 28.5%, B: 57% and C-D: 14.5%. HCC has been treated with loco-regional treatment in 78.5% of our patients, while the rest have received sorafenib. Twenty-eight patients (66.5%) died due to HCC with a median survival time of 6 months (range: 2-60). Using the Cox proportional hazard model, the only factors associated with poor survival were BCLC stages C and D.
CONCLUSIONS
CONCLUSIONS
In conclusion, BCLC staging is the main prognostic factor of survival in patients with TDT who develop HCC.
Identifiants
pubmed: 32180908
doi: 10.4084/MJHID.2020.013
pii: mjhid-12-1-e2020013
pmc: PMC7059739
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e2020013Déclaration de conflit d'intérêts
Competing interests: The authors declare no conflict of Interest.
Références
Haematologica. 2004 Oct;89(10):1187-93
pubmed: 15477202
Ann Hepatol. 2016 Jan-Feb;15(1):82-90
pubmed: 26626644
Hepatology. 2003 Feb;37(2):429-42
pubmed: 12540794
J Hepatol. 2017 Aug;67(2):302-309
pubmed: 28336466
Liver Int. 2007 Aug;27(6):735-41
pubmed: 17617115
Cancer Lett. 2009 Dec 1;286(1):38-43
pubmed: 19081672
Blood. 1998 Nov 1;92(9):3460-4
pubmed: 9787188
Gastrointest Tumors. 2014 Aug;1(3):135-45
pubmed: 26676160
N Engl J Med. 2008 Jul 24;359(4):378-90
pubmed: 18650514
Br J Haematol. 2014 Oct;167(1):121-6
pubmed: 24992281
Lancet. 2004 Jan 31;363(9406):357-62
pubmed: 15070565
J Hepatol. 2018 Aug;69(2):461-511
pubmed: 29650333
Liver Cancer. 2014 Mar;3(1):31-40
pubmed: 24804175
Transfus Med. 2000 Sep;10(3):175-80
pubmed: 10972911
Indian J Med Res. 2011 Oct;134:572-6
pubmed: 22089622
Blood. 2009 May 14;113(20):4853-5
pubmed: 19264677
Am J Hematol. 2005 Feb;78(2):158-9
pubmed: 15682406
World J Hepatol. 2010 May 27;2(5):171-4
pubmed: 21160991
J Hepatocell Carcinoma. 2016 Oct 05;3:41-53
pubmed: 27785449
Br J Haematol. 2010 Jul;150(2):245-7
pubmed: 20433678
Semin Liver Dis. 2010 Feb;30(1):61-74
pubmed: 20175034
Ann Intern Med. 2013 Mar 5;158(5 Pt 1):329-37
pubmed: 23460056
Hepatology. 2010 Apr;51(4):1274-83
pubmed: 20112254
Blood. 2002 Jun 15;99(12):4588-91
pubmed: 12036892
Cancer. 2017 Mar 1;123(5):751-758
pubmed: 27911488
Oncotarget. 2018 May 18;9(38):25075-25088
pubmed: 29861854
J Hepatol. 2012 Jun;56(6):1330-5
pubmed: 22314428
J Hepatol. 2018 Jul;69(1):182-236
pubmed: 29628281
J Hepatol. 2016 Apr;64(4):800-6
pubmed: 26678008
Toxicol Appl Pharmacol. 2015 Feb 1;282(3):237-43
pubmed: 25545986
Anaesthesia. 2014 May;69(5):494-510
pubmed: 24601913
Ann Gastroenterol. 2017;30(3):357-363
pubmed: 28469367