Abstract
BackgroundImprovements in antimetabolite drugs have prolonged the survival of patient with hematological malignancies. However, these drugs may have hepatotoxic side effects and may induce acute liver failure, chronic liver fibrosis, cirrhosis, or even hepatocellular carcinoma (HCC). Although liver resection remains a curative option for HCC, its role in HCC with hematological malignancies has never been fully explored.MethodsA retrospective review of 1725 patients who underwent curative liver resection for newly diagnosed HCC between 1994 and 2016 was conducted. Among these patients, 16 had a history of hematological malignancies (HM group). Their hematological malignancies were well-controlled at the time of liver resection. The clinicopathological characteristics of the HM group, along with their short- and long-term outcomes after liver resection, were compared with those of the other 1709 patients without hematological malignancy (non-HM group).ResultsAll HM group patients were seropositive for hepatitis marker surface for hepatitis B and C. No significant differences were observed in any background characteristics between the two groups. The postoperative complication rate and 90-day mortality in the HM and non-HM groups were 25 and 20.4%, P = 0.754, and 0 and 0.6%, P = 1.000, respectively. The 5-year disease-free and overall survival rates for the HM and non-HM groups were 42.3 and 35.1%, P = 0.552, and 69.5 and 56.9%, P = 0.192, respectively.ConclusionsHepatitis markers should be examined during chemotherapy for hematological malignancies. Regular liver imaging studies are recommended for seropositive cases. When HCC occurs secondary to a well-controlled hematological malignancy, liver resection is suggested in selected patients.
Highlights
Improvements in antimetabolite drugs have prolonged the survival of patient with hematological malignancies
The hepatocellular carcinoma (HCC) in 3 patients were detected during the course of chemotherapy, while the HCCs in the other 13 patients were detected at an average of 79 months after hematological treatment
The clinical characteristics of all patients who underwent liver resection are shown in Table 2 [20]
Summary
Improvements in antimetabolite drugs have prolonged the survival of patient with hematological malignancies. These drugs may have hepatotoxic side effects and may induce acute liver failure, chronic liver fibrosis, cirrhosis, or even hepatocellular carcinoma (HCC). Outcomes of hematological malignancies have improved substantially and survival times have markedly increased due to the progression of antimetabolite therapies [1]. Acute hepatocyte necrosis and fulminant liver failure may occur after administration of these agents, especially in patients with chronic hepatitis B or C infection [2, 3]. Antimetabolite drugs may cause methylation of mitochondrial DNA in hepatocytes, resulting in phenotypic changes, and may induce malignant change in hepatocytes leading to subsequent primary hepatocellular carcinoma (HCC) formation [4, 5]. When patients with hepatitis have hematological malignancies, the hepatocytes that have been injured by hepatitis B or C may be more susceptible to
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