Carcinovic cohort: prognostic factors of death in HIV/HCV coinfected patients with hepatocellular carcinoma (HCC)
© Gelu-Simeon et al; licensee BioMed Central Ltd. 2014
Published: 23 May 2014
Background and aim
We have previously reported a more advanced radiological presentation in HIV+/HCV+ than HIV-/HCV+ patients (pts). The aim of our study was to define prognostic factors of death in HIV+/HCV+ pts with HCC.
Cases of HCC in HIV+/HCV+ pts were obtained from the 3 ANRS Prethevic, HepaVih and CirVir cohorts. Imaging was reviewed according to EASL criteria.
Fifty HIV+/HCV+ coinfected pts (n=44 men (88%), median age 50 years [40-74], median CD4 cell count 334/mm3 [58-1621], n=28 Child A cirrhosis (60%)) developed HCC. Thirty-one (63%) pts presented cirrhosis decompensation before HCC diagnosis. At HCC diagnosis, median serum aFP was 20.4 [1.9-198,900] ng/ml, 38 (76%) pts had a nodular tumor (median main diameter 23.5 [11-70] cm) and 12 (24%) pts an infiltrating form (62.5 [10-130] cm), p=0.007. Tumor portal thrombosis was diagnosed in 14 (28%) pts. A curative or a palliative procedure was further performed in 22 (44%) pts and 20 (40%) pts, respectively. The 2-years and 4-years overall survival rates were 51% and 28%, respectively. Age (p=0.0005), infiltrating or nodular tumor (p= 0.0009) and tumor portal thrombosis (p=0.004) were associated to survival. In a Cox model, two prognostic factors of deaths were found: prior episode of cirrhosis decompensation (aRR 11.43 [3.01-43.34], p=0.0003) and tumor portal thrombosis (aRR 4.66 [1.19-18.27], p=0.03), adjusted on age, CD4 cell count and the therapeutic strategy for HCC.
Cirrhosis decompensation and tumor portal thrombosis significantly impact the survival of HIV+/HCV+ pts with HCC. Our results suggest new rules of screening HCC in HIV+/HCV+ pts with advanced liver disorders.
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