Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2024; 16(9): 3851-3864
Published online Sep 15, 2024. doi: 10.4251/wjgo.v16.i9.3851
Retrospective analysis of patients with hepatocellular carcinoma complicated with human immunodeficiency virus infection after hepatectomy
Jia-Jie Lu, Shuai Yan, Lin Chen, Lin-Ling Ju, Wei-Hua Cai, Jin-Zhu Wu
Jia-Jie Lu, Department of Hepatobiliary Surgery, Nantong Third People's Hospital, Medical School of Nantong University, Nantong 226000, Jiangsu Province, China
Shuai Yan, Department of Medical School, Nantong University, Nantong 226300, Jiangsu Province, China
Lin Chen, Lin-Ling Ju, Institute of Liver Disease, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226000, Jiangsu Province, China
Wei-Hua Cai, Jin-Zhu Wu, Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, Jiangsu Province, China
Co-first authors: Jia-Jie Lu and Shuai Yan.
Author contributions: Lu JJ wrote the paper; Yan S analyzed the data and outcomes; Chen L contributed analytic tools; Ju LL collected the data; Cai WH contributed new reagents; Wu JZ designed the research; all authors have read and approved the final version. Lu JJ and Yan S contributed equally to this work as co-first authors. There are three reasons for appointing Lu JJ and Yan S as co-first authors. First, the study was conducted as a collaborative effort, and the designation of co-first author accurately reflects the allocation of responsibilities and burdens associated with the time and effort required to complete the research and final paper. This also ensures effective communication and management of post-submission transactions, ultimately improving the quality and reliability of the paper. Second, the entire research team includes authors with a wide range of expertise and skills from different fields, and the designation of co-first author best reflects this diversity. This also promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching the reader's understanding by providing a variety of expert perspectives. Third, Lu JJ and Yan S made equally important contributions in the whole research process. The selection of these researchers as co-first authors is a recognition and respect for their equal contribution, as well as a recognition of the teamwork spirit of this research. To sum up, we feel that the designation of Lu JJ and Yan S as co-first authors is appropriate for our manuscript, as it accurately reflects our team's spirit of cooperation, equal contribution and diversity.
Supported by Nantong Municipal Health Commission, No. MSZ2022036.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no competing interests. All authors issued final approval for the version to be submitted for publication.
Data sharing statement: Enquiries about data access should be made to the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Zhu Wu, MD, Chief, Chief Doctor, Professor, Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, No. 19 Qixiu Road, Chongchuan District, Nantong 226006, Jiangsu Province, China. wjz1258@163.com
Received: May 12, 2024
Revised: July 30, 2024
Accepted: August 15, 2024
Published online: September 15, 2024
Processing time: 119 Days and 11.4 Hours
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide, with a 5-year relative survival rate of approximately 18%. The similarity between incidence and mortality (830000 deaths per year) underscores the bleak prognosis associated with the disease. HCC is the fourth most common malignancy and the second leading cause of cancer death in China. Most patients with HCC have a history of chronic liver disease such as chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, alcoholism or alcoholic steatohepatitis, nonalcoholic fatty liver disease, or nonalcoholic steatohepatitis. Early diagnosis and effective treatment are the keys to improving the prognosis of patients with HCC. Although the total number of human immunodeficiency virus (HIV)-infected patients is declining globally the incidence of HCC is increasing in HIV-infected patients, especially those who are coinfected with HBV or HCV. As a result, people infected with HIV still face unique challenges in terms of their risk of developing HCC.

AIM

To investigate the survival prognosis and clinical efficacy of surgical resection in patients with HCC complicated with HIV infection.

METHODS

The clinical data of 56 patients with HCC complicated with HIV admitted to the Third Affiliated Hospital of Nantong University from January 2013 to December 2023 were retrospectively analyzed. Among these, 27 patients underwent hepatectomy (operation group) and 29 patients received conservative treatment (nonoperation group). All patients signed informed consents in line with the provisions of medical ethics. The general data, clinicopathological features and prognoses for the patients in the two groups were analyzed and the risk factors related to the prognoses of the patients in the operation group were identified.

RESULTS

The median disease-free survival (DFS) and overall survival (OS) of HIV-HCC patients in the surgical group were 13 months and 17 months, respectively, and the median OS of patients in the nonsurgical group was 12 months. The OS of the surgical group was significantly longer than that of the control group (17 months vs 12 months, respectively; P < 0.05). The risk factors associated with DFS and OS in the surgical group were initial HIV diagnosis, postoperative microvascular invasion (MVI), a CD4+ T-cell count < 200/μL, Barcelona stage C-D, and men who have sex with men (MSM; P < 0.05).

CONCLUSION

Hepatectomy can effectively prolong the survival of patients with HIV-HCC but MVI identified during postoperative pathological examination, late tumor detection, late BCLC stage, CD4+ T < 200/μL and MSM are risk factors affecting the survival and prognosis of patients undergoing hepatectomy. In addition, there were significant differences between the surgical group and the nonsurgical group in terms of the initial diagnosis of HIV, Child-Pugh score, alpha-fetoprotein measurement value, and HART-efficient antiretroviral therapy after the diagnosis of HIV (P < 0.05). Therefore, these factors may also affect the survival and prognosis of patients.

Keywords: Hepatocellular carcinoma; Human Immunodeficiency virus; Liver resection; Retrospective analysis; Prognosis

Core Tip: Human immunodeficiency virus (HIV) infection significantly influences treatment strategies for hepatocellular carcinoma (HCC). When developing treatment plans, health care workers must consider the complexity of the immune status of HIV-infected patients and the potential drug interactions resulting from antiretroviral therapy. For HIV-positive HCC patients, HIV infection itself may influence tumor biology and patient response to treatment, thus affecting the cure, recurrence, and long-term survival rates of the disease. Therefore, health care professionals treating HIV-HCC patients must collaborate across disciplines to thoroughly understand the patient's overall condition and develop a comprehensive, personalized treatment plan. To effectively control HIV infection, HCC should be treated and the quality of life of patients should be optimized.