Paper # 685 
Screening for Hepatocellular Carcinoma in HIV/HCV Co-infected Patients: Impact on Staging, Therapy, and Survival
Marina Nunez*1, L Kikuchi2, P Barreiro3, M Nelson4, M E Vispo3, E Page4, R Fox5, E Bini6, M Sherman7, N Bräu8, and Atlantic Liver Cancer in HIV Study Group
1Wake Forest Univ Sch of Med, Winston-Salem, NC, US; 2Univ of Sao Paulo, Brazil; 3Hosp Carlos III, Madrid, Spain; 4Chelsea and Westminster Hosp, London, UK; 5Univ of California, San Francisco, US; 6New York Univ Sch of Med, NY, US; 7Univ of Toronto, Canada; and 8Mt Sinai Sch of Med, New York, NY, US
Background: Current recommendations for
Hepatocellular Carcinoma (HCC) screening in HCV-infected patients with
cirrhosis (liver sonography every 6 to 12 months) are based on expert opinions,
since there are no randomized controlled studies that show a survival benefit.
No data are available on HCC screening in HIV/HCV-co-infected patients. This
international cohort study of HIV/HCV co-infected patients with HCC compared
outcomes in patients with and without prior HCC screening.
Methods: HIV-infected patients with HCV-related HCC
were retrospectively identified between 1992 to 2009 in 20 centers in North and
South America and Europe. Each HCC diagnosis was confirmed using the 2005 AASLD
criteria. Patients were considered screened if they initially presented with an
abnormal AFP level or liver imaging study, and not screened if they presented
with symptoms.
Results: We identified 70 HIV/HCV co-infected
patients with HCC, of whom 39 (55.7%) were screened. There was no significant
difference between screened and non-screened patients in mean age (50.2 vs 53.3
years, P =0.10), race/ethnicity (black, 44% vs 55%; white, 44% vs
26%; Latino, 13% vs 19%; P =0.29), median HIV RNA level (<400 vs
895 copies/mL, P =0.27), and median CD4+ cell count (308
vs 227 per mm3, P =0.25). However, screened patients
were more likely than non-screened patients to present with earlier Barcelona
Clínic Liver Cancer (BCLC) stages A or B (69.2% vs 19.4%, P <0.001),
had a lower mean Cancer of the Liver Italian Program (CLIP) staging score (1.6
vs 2.5, P =0.009), a lower mean Child-Turcotte-Pugh (CTP) score
(6.6 vs 7.5, P =0.027), had more commonly CTP stage A (61.5% vs
35.5%, P =0.030), and they tended to more commonly receive
effective HCC therapy (64.1% vs 41.9%, P =0.064). After adjustment
for lead time (calculated as 176 days using the tumor doubling time method),
screened vs non-screened patients had a longer median survival (6.9 vs 3.8
months, P =0.026).
Conclusions: This retrospective study shows that a
large proportion of HIV/HCV co-infected patients with HCC were not screened for
the malignancy. Yet, screening for HCC among HIV/HCV-co-infected patients was
associated with significantly earlier HCC stage, increased use of effective HCC
therapy, and with improved survival after adjustment for lead time bias. These
findings support the AASLD 2005 practice guidelines for HCC screening that can
also be applied to HIV/HCV co-infected patients.
|
