Treatment and Outcomes of Hepatocellular Carcinoma in Patients with Sickle Cell Disease: A Population-Based study in the U.S.,HPB

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Treatment and Outcomes of Hepatocellular Carcinoma in Patients with Sickle Cell Disease: A Population-Based study in the U.S.
HPB ( IF 2.7 ) Pub Date : 2021-07-06 , DOI: 10.1016/j.hpb.2021.06.420
Arianna Barbetta ₁ , Cameron Goldbeck ₁ , Angelina Lim ₁ , Sean P Martin ₂ , Jeffrey A Kahn ₃ , M Raashid Sheikh ₁ , Juliet Emamaullee ₁

Affiliation

Background

Sickle cell disease (SCD) is a rare hemoglobinopathy which can result in chronic liver disease and cirrhosis. Patients with SCD have an increased risk of hematologic malignancy, but the prevalence of hepatocellular carcinoma (HCC) in this population is unknown. Herein, the association of SCD with HCC was examined using registry data.

Methods

The SEER-Medicare database was queried to identify patients diagnosed with HCC between 2000 and 2015, and further stratified by SCD status. Propensity matching was performed to examine cancer-related survival and treatment outcomes.

Results

Overall 56,934 patients with HCC were identified, including 81 patients with SCD. Patients with SCD more frequently had cirrhosis [48.1% (39/81) vs 23.5% (13,377/56,853), p<0.01] yet presented with smaller tumors [<5 cm: 51.9% (42/81) vs 38.5% (21,898/56,853), p=0.01]. After propensity matching, SCD was not associated with attenuated survival (aHR 0.73 95%CI 0.52-1.01). When stratified by treatment, patients with SCD had equivalent outcomes to chemotherapy (p=0.65), TACE/TARE (p=0.35), resection (p=0.15) and transplantation (p=0.67) when compared to non-SCD patients.

Conclusion

This study confirms that a subset of patients with SCD will develop HCC. Importantly, therapeutic options for HCC should not be limited by pre-existing SCD, and similar survival should be expected when compared to non-SCD patients.

中文翻译：

镰状细胞病患者肝细胞癌的治疗和结果：美国的一项基于人群的研究

背景

镰状细胞病（SCD）是一种罕见的血红蛋白病，可导致慢性肝病和肝硬化。 SCD 患者患血液系统恶性肿瘤的风险增加，但该人群中肝细胞癌 (HCC) 的患病率尚不清楚。在此，使用登记数据检查了 SCD 与 HCC 的关联。

方法

查询 SEER-Medicare 数据库以确定 2000 年至 2015 年间诊断为 HCC 的患者，并按 SCD 状态进一步分层。进行倾向匹配来检查癌症相关的生存和治疗结果。

结果

总共确定了 56,934 名 HCC 患者，其中包括 81 名 SCD 患者。 SCD 患者更常见肝硬化 [48.1% (39/81) vs 23.5% (13,377/56,853), p<0.01]，但肿瘤较小 [<5 cm：51.9% (42/81) vs 38.5% (21,898/56,853)，p=0.01]。倾向匹配后，SCD 与生存率降低无关（aHR 0.73 95%CI 0.52-1.01）。按治疗分层时，与非 SCD 患者相比，SCD 患者在化疗 (p=0.65)、TACE/TARE (p=0.35)、切除 (p=0.15) 和移植 (p=0.67) 方面具有相同的结局。