Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 1;12(1):e2020013.
doi: 10.4084/MJHID.2020.013. eCollection 2020.

Characteristics and Prognosis of Hepatocellular Carcinoma in Multi-Transfused Patients with β-Thalassemia. Experience of a Single Tertiary Center

Nikolaos Papadopoulos  1 , Dimitrios Kountouras  2 , Katerina Malagari  3 , Maria Tampaki  2 , Maria Theochari  2 , John Koskinas  2
Affiliations

Characteristics and Prognosis of Hepatocellular Carcinoma in Multi-Transfused Patients with β-Thalassemia. Experience of a Single Tertiary Center

Nikolaos Papadopoulos et al. Mediterr J Hematol Infect Dis. .

Abstract

Background/aim: The incidence of hepatocellular carcinoma (HCC) in patients with transfusion dependent thalassemia (TDT) has been increasing, where viral hepatitis and iron overload are the two established HCC risk factors. The aim of this study was to investigate the etiological factors of HCC development and to evaluate the possible factors associated with survival in our cohort of TDT patients with HCC.

Methods: Records of patients with TDT diagnosed with HCC from 2008 to 2018 were reviewed. Liver iron concentration (LIC) has been assessed by the signal-intensity-ratio MRI. The diagnosis of HCC was made by a 3-phase contrast magnetic resonance imaging (MRI) and patients were staged and treated for HCC according to Barcelona Clinic Liver Cancer (BCLC) grading system.

Results: Forty-two TDT patients with HCC have been included. Most of them (78.5%) were anti-HCV positive, 59.5% HCV-RNA positive, and 16.5% had serological markers of resolved HBV infection. Patients with HCV infection have been treated successfully with either Peg-IFNa±Ribavirin or with the new direct antivirals (DAAs). At the time of HCC diagnosis, all patients with chronic HCV infection were HCV-RNA negative, 78.5% had underlying cirrhosis, and the vast majority (98%) had average or mild elevated LIC values. According to the BCLC system, patients were classified as 0-A: 28.5%, B: 57% and C-D: 14.5%. HCC has been treated with loco-regional treatment in 78.5% of our patients, while the rest have received sorafenib. Twenty-eight patients (66.5%) died due to HCC with a median survival time of 6 months (range: 2-60). Using the Cox proportional hazard model, the only factors associated with poor survival were BCLC stages C and D.

Conclusions: In conclusion, BCLC staging is the main prognostic factor of survival in patients with TDT who develop HCC.

Keywords: Cirrhosis; Hemosiderosis; Hepatocellular carcinoma (HCC); Thalassemia major (TM); Viral hepatitis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: The authors declare no conflict of Interest.

Figures

Figure 1
Figure 1
Overall Kaplan-Meier survival curve.
Figure 2
Figure 2
Kaplan-Meier survival curve according BCLC staging.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Moukhadder HM, Halawi R, Cappellini MD, Taher AT. Hepatocellular carcinoma as an emerging morbidity in the thalassemia syndromes: a comprehensive review. Cancer. 2017;123:751–758. doi: 10.1002/cncr.30462. - DOI - PubMed
    1. Loukopoulos D. Haemoglobinopathies in Greece: prevention programme over the past 35 years. Indian J Med Res. 2011;134:572–6. - PMC - PubMed
    1. Borgna-Pignatti C, Garani MC, Forni GL, Cappellini MD, Cassinerio E, Fidone C, Spadola V, Maggio A, Restivo Pantalone G, Piga A, Longo F, Gamberini MR, Ricchi P, Costantini S, D’Ascola D, Cianciulli P, Lai ME, Carta MP, Ciancio A, Cavalli P, Putti MC, Barella S, Amendola G, Campisi S, Capra M, Caruso V, Colletta G, Volpato S. Hepatocellular carcinoma in thalassaemia: an update of the Italian Registry. Br J Haematol. 2014;167:121–126. doi: 10.1111/bjh.13009. - DOI - PubMed
    1. Nikolopoulou G, Zisouli A. Viral hepatitis. Available from: http://www.keelpno.gr/en-us/home.aspx.
    1. Kyriakis KP, Foudoulaki LE, Papoulia EI, Sofroniadou KE. Seroprevalence of hepatitis B surface antigen (HBsAg) among first-time and sporadic blood donors in Greece: 1991–1996. Transfusion Medicine. 2000;10:175–180. doi: 10.1046/j.1365-3148.2000.00257.x. - DOI - PubMed