Schistosoma mansoni infection and the occurrence, characteristics, and survival of patients with hepatocellular carcinoma: an observational study over a decade

ABSTRACT

Schistosoma mansoni infection (SMI) is suspected to be directly and indirectly involved in hepato-carcinogenesis. This study evaluated the association of a previous SMI with hepatocellular carcinoma (HCC) development, patients, tumor characteristics, treatment outcomes, and survival. This observational study included patients with HCC with and without previous SMI who presented to the multidisciplinary HCC clinic, Kasr-Alainy hospital (November 2009 to December 2019). It also included 313 patients with liver cirrhosis without HCC. Clinical and laboratory features of the patients (complete blood count, liver/renal functions , alpha-fetoprotein, and hepatitis B/C status), tumor characteristics (Triphasic CT and/or dynamic MRI), liver stiffness (transient elastography), HCC treatment outcome, and overall survival were studied. This study included 1446 patients with HCC; 688(47.6%) composed group-1, defined by patients having a history of SMI, and 758(52.4%) were in group-2 and without history of SMI. Male sex, smoking, diabetes mellitus, splenomegaly, deteriorated performance status, synthetic liver functions, and platelet count were significantly higher in group-1. The groups did not differ with regard to liver stiffness, tumor characteristics, or the occurrence of post-HCC treatment hepatic decompensation or recurrence. HCC treatment response was better in group-2. Group-1 showed lower sustained virological response to hepatitis C direct-acting antivirals (DAAs) compared with group-2 (60% versus 84.3%, respectively, P = 0.027). Prior SMI was associated with HCC (adjusted odds ratio = 1.589, 95% confidence interval = 1.187–2.127), and it was concluded that it increases the risk of HCC. In addition, it significantly affects the performance status, laboratory characteristics, response to DAAs, and overall survival.

KEYWORDS:

• Hepatocellular carcinoma
• hepatitis c virus
• schistosomiasis
• schistosoma mansoni
• survival
• direct-acting antiviral (daa)

Acknowledgments

The authors acknowledge the Cairo University Centre for Hepatic Fibrosis, Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt for providing the Transient Elastography machine for assessment of liver stiffness.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics statement

The protocol of this manuscript was approved by the ethics committee of the Faculty of Medicine, Cairo University number: N-45-2021.

Additional information

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This work has not been published previously, is not under consideration for publication elsewhere, its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out and, if accepted, will not be published elsewhere including electronically in the same form, in English or any other language, without the written consent of the copyright holder. All relevant data are within the manuscript and its Supporting Information files.