代谢相关脂肪性肝病对晚期肝细胞癌索拉菲尼治疗影响分析

Impact of metabolism⁃associated fatty liver disease on outcome of sorafenib therapy in advanced hepatocellular carcinoma

目的:探讨代谢相关脂肪性肝病(MAFLD)对晚期肝细胞癌(HCC)口服索拉菲尼治疗长期预后的影响及其独立危险因素。方法:回顾性分析2016年9月至2019年8月在扬州大学附属兴化人民医院接受索拉菲尼治疗的晚期肝细胞癌患者的临床资料。依据是否患有MAFLD进行分组,分析入组患者性别、年龄、肝硬化、既往接受治疗、肝硬度、门静脉内径、生化学指标及预后等临床资料。以总体生存期(OS)为主要研究终点,以无进展生存期(PFS)为次要研究终点,分析评估患者生存期相关的独立危险因素。结果:93例晚期肝细胞癌患者被纳入研究,分为MAFLD组(n=22)和非MAFLD组(n=71)。两组BMI、HBV/HCV、Ⅱ型糖尿病、心血管疾病、HCC子灶数量等指标比较,差异有统计学意义(P<0.05)。MAFLD组中位OS及PFS较非MAFLD组更长(P<0.05)。BMI、HBV/HCV、Child Pugh分级、血清AFP浓度与预后相关性显著。结论:MAFLD组患者可以从索拉菲尼治疗中获得较好的生存获益,BMI、HBV/HCV、Child Pugh分级以及血清AFP浓度是影响晚期HCC患者索拉菲尼治疗疗效的独立危险因素。MAFLD组预后较好的原因可能与肝脏基础疾病,如肝炎病毒感染和肝硬化对晚期肝细胞癌索拉菲尼治疗影响更大有关,但仍需引导患者积极克服MAFLD。

Objective:To investigate the impact of metabolism⁃associated fatty liver disease(MAFLD)on long⁃term prognosis of sorafenib therapy in advanced hepatocellular carcinoma(HCC)and its independent risk factors.Methods:The clinical data of patients with advanced HCC given sorafenib therapy in Xinghua People's Hospital Affiliated to Yangzhou University between September 2016 and August 2019 were retrospectively analyzed.The patients were divided into two groups according to whether they had MAFLD.The included patients were reviewed on clinical data such as gender,age,liver cirrhosis,previous treatment,liver stiffness,portal vein diameter,biochemical indexes and prognosis.The primary endpoint was overall survival(OS),and the secondary endpoint was the progression⁃free survival(PFS).Independent risk factors related to patient survival were analyzed and evaluated.Results:Ninety⁃three patients with advanced HCC were enrolled and divided into the MAFLD group(n=22)and non⁃MAFLD group(n=71).The two groups differed statistically in BMI,HBV/HCV,type 2 diabetes,cardiovascular disorder,and the number of HCC lesions(P<0.05).The median OS and PFS were longer in the MAFLD group than those in the non⁃MAFLD group(P<0.05).BMI,HBV/HCV,Child⁃Pugh grade,and serum AFP level were significantly correlated with the prognosis(P<0.05).Conclusion:MAFLD patients can benefit more in survival from sorafenib therapy.BMI,HBV/HCV,Child⁃Pugh grade and serum AFP level are independent risk factors affecting the efficacy of sorafenib therapy in advanced HCC patients.The better prognosis in the MAFLD group may be attributed to the greater impact of underlying hepatic diseases(e.g.infection with hepatitic viruses,liver cirrhosis)on sorafenib therapy for advanced HCC.Notwithstanding this,proactive guidance should be given to these patients to address the MAFLD.