The concern of iron-replacement therapy on hepatocellular carcinoma in a patient with mild anemia

这篇有趣的病例报告描述了1例因自行服用铁剂以纠正贫血而致肝细胞癌发生进展,但在停用铁剂后病情得以稳定的肝细胞癌病例,提示补铁与肝细胞癌进展之间可能存在一定的关联,并探讨了相关机制,提醒临床上应对此类情况引起关注。

Background and Objective： Anemia is very common in cancer patients with many etiologies. Palliative care patients also have a number of risk factors for iron-deficiency anemia. Prescribers of iron- replacement therapy often overlook that iron-loading can negatively affect the cancer prognosis.Methods and results： A 66-year-old male was diagnosed with hepatitis B virus-related hepatocellular carcinoma （HCC）. After resection, he received the transarterial chemo-embolization （TACE） and radiofrequency ablation （RFA） on the recurred HCC. He was also diagnosed with renal cell carcinoma （RCC）, and received RFA. Meanwhile, his hemoglobin level was slightly low （11.0 g/dL）. After 21 months, his HCC recurred, together with a significant rise in blood hemoglobin level from 11.0 to 15.0 g/dL due to oral iron supplementation. Further TACE was recommended but refused by the patient. Only after discontinuation of the iron supplement, the follow-up MRI scans did prove that the recurrent tumor improved as the hemoglobin level returned to 11.0 g/dL. His disease is currently stable.Conclusion： Iron-replacement therapy should not be indiscriminately prescribed to all cancer patients with anemia. Further studies about the effect of mild iron deprivation on survival in the palliative care population are necessary since mildly low hemoglobin index can be beneficial to the prognosis of HCC in this case.