Clinical characteristics and treatment outcomes in patients with liver cirrhosis and lymphoma

• 作者: Ana M Monta?a-Duclaud Andrea Cavazos-Gómez Astrid Ruiz-Margáin JoséA González-Regueiro Mariana Cruz-Contreras Ricardo U Macías-Rodríguez Roberta Demichelis-Gómez
• 来源期刊: 世界肝病学杂志:英文版(电子版)
• 学科: 医学
• 关键词: CIRRHOSIS Cancer LYMPHOMA CHEMOTHERAPY Treatment Survival TOXICITY ADVERSE events
• 年，卷（期）: 2020,（2）
• 页码范围: 34-45
• 页数: 12页
• 分类号: R73

摘要

BACKGROUND A significant number of patients with liver cirrhosis concomitantly develop some type of solid or hematological cancer,including lymphoma.Treatment of patients with lymphoma and cirrhosis is challenging for physicians due to the clinical characteristics related to cirrhosis,including biochemical and functional abnormalities,as well as portal hypertension and lack of scientific evidence,limiting the use of chemotherapy.Currently,experts recommend only offering oncological treatment to patients with compensated cirrhosis.AIM To evaluate the clinical characteristics and treatment outcomes in patients with cirrhosis and lymphoma treated with chemotherapy.METHODS This was a case-control study conducted at a tertiary care center in Mexico.Data was recorded from medical files and from 8658 possible candidates with cirrhosis and/or lymphoma(2000 to 2018).Only 23 cases had both diseases concomitantly;10 patients with cirrhosis and lymphoma(cases)met the selection criteria and were included,and 20 patients with lymphoma(controls)were included and matched according to age,sex,and date of diagnosis,type and clinical stage of lymphoma.All patients received treatment with chemotherapy.For statistical analysis,descriptive statistics,Shapiro-Wilk test,Mann-Whitney U test,chisquare test and Fisher's exact test were used.Survival was evaluated using Kaplan-Meier curves and Log-rank test.RESULTS There were differences in biochemical variables inherent to liver disease and portal hypertension in patients with cirrhosis.The most frequent etiology of cirrhosis was hepatitis C virus(50%);80%were decompensated,the median Child-Turcotte-Pugh score was 7.5(6.75-9.25),and mean Model for End-stage Liver Disease was 11.5±4.50.Regarding lymphomas,non-Hodgkin's were the most common(90%),and diffuse large B cell subtype was the most frequent,with a higher International Prognostic Index in the cases(3 vs 2,P=0.049).The chemotherapy regimens had to be adjusted more frequently in the case group(50%vs 5%,P=0.009).The complications deriv