ABSTRACT

Schistosoma mansoni infection (SMI) is suspected to be directly and indirectly involved in hepato-carcinogenesis. This study evaluated the association of a previous SMI with hepatocellular carcinoma (HCC) development, patients, tumor characteristics, treatment outcomes, and survival. This observational study included patients with HCC with and without previous SMI who presented to the multidisciplinary HCC clinic, Kasr-Alainy hospital (November 2009 to December 2019). It also included 313 patients with liver cirrhosis without HCC. Clinical and laboratory features of the patients (complete blood count, liver/renal functions , alpha-fetoprotein, and hepatitis B/C status), tumor characteristics (Triphasic CT and/or dynamic MRI), liver stiffness (transient elastography), HCC treatment outcome, and overall survival were studied. This study included 1446 patients with HCC; 688(47.6%) composed group-1, defined by patients having a history of SMI, and 758(52.4%) were in group-2 and without history of SMI. Male sex, smoking, diabetes mellitus, splenomegaly, deteriorated performance status, synthetic liver functions, and platelet count were significantly higher in group-1. The groups did not differ with regard to liver stiffness, tumor characteristics, or the occurrence of post-HCC treatment hepatic decompensation or recurrence. HCC treatment response was better in group-2. Group-1 showed lower sustained virological response to hepatitis C direct-acting antivirals (DAAs) compared with group-2 (60% versus 84.3%, respectively, P = 0.027). Prior SMI was associated with HCC (adjusted odds ratio = 1.589, 95% confidence interval = 1.187–2.127), and it was concluded that it increases the risk of HCC. In addition, it significantly affects the performance status, laboratory characteristics, response to DAAs, and overall survival.

摘要

曼氏血吸虫感染（SMI）被怀疑直接和间接地参与了肝癌的发生。本研究评估了既往 SMI 与肝细胞癌 (HCC) 发展、患者、肿瘤特征、治疗结果和生存率的关系。这项观察性研究包括在多学科 HCC 诊所 Kasr-Alainy 医院（2009 年 11 月至 2019 年 12 月）就诊的患有和未患有 SMI 的 HCC 患者。它还包括 313 名无 HCC 的肝硬化患者。患者的临床和实验室特征（全血细胞计数、肝/肾功能、甲胎蛋白和乙型/丙型肝炎状态）、肿瘤特征（三相 CT 和/或动态 MRI）、肝脏硬度（瞬时弹性成像）、HCC 治疗结果和总生存期进行了研究。这项研究包括 1446 名 HCC 患者；688 人（47.6%）组成第 1 组，定义为有 SMI 病史的患者，758 人（52.4%）属于第 2 组且无 SMI 病史。男性、吸烟、糖尿病、脾肿大、体力状态恶化、合成肝功能和血小板计数在第 1 组中显着升高。各组在肝脏硬度、肿瘤特征或 HCC 治疗后肝脏失代偿或复发的发生率方面没有差异。HCC 治疗反应在第 2 组中更好。与第 2 组相比，第 1 组对丙型肝炎直接作用抗病毒药物 (DAA) 的持续病毒学应答较低（分别为 60% 和 84.3%，P = 0.027）。既往 SMI 与 HCC 相关（调整优势比 = 1.589，95% 置信区间 = 1.187-2.127），并得出结论认为它会增加 HCC 的风险。此外，