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慢性丙型肝炎患者肝细胞癌发生相关影响因素分析。组织学诊断后的长期随访研究。

Analysis of factors affecting the appearance of hepatocellular carcinoma in patients with chronic hepatitis C. A long term follow-up study after histologic diagnosis.

作者信息

Aizawa Y, Shibamoto Y, Takagi I, Zeniya M, Toda G

机构信息

Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.

出版信息

Cancer. 2000 Jul 1;89(1):53-9.

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) occurs more frequently in patients with hepatitis C virus (HCV)-related chronic liver disease than those with hepatitis B virus-related disease. It is important to assess the factors affecting the development of HCC.

METHODS

A long term follow-up study involving patients with chronic HCV was performed retrospectively. A total of 153 patients diagnosed between June 1981 and November 1990 with chronic HCV with or without cirrhosis by liver biopsy were enrolled in a long term follow-up study (average, 99.4 months) and the cumulative incidence rate of HCC and factors affecting the appearance of HCC were examined.

RESULTS

The 5-year cumulative incidence rate was 9%, the 10-year cumulative incidence rate was 23%, and the 15-year cumulative incidence rate was 42%. The annual rate of incidence increased as the follow-up period progressed. The authors selected ten variables and investigated their effect on the incidence rate of HCC, including age, gender, habitual heavy drinking, positivity of antibody against hepatitis B virus surface antigen, treatment with interferon (IFN) during the follow-up period, maximum and minimum serum alanine aminotransferase levels during the follow-up period, histologic staging, grading, and irregular regeneration of hepatocytes. Of the 10 variables, age (> 50 years), habitual heavy drinking, and histologic staging were determined to be independent risk factors according to multivariate Cox proportional hazards regression analysis. IFN therapy by itself was not found to be an independent factor affecting the appearance of HCC.

CONCLUSIONS

In patients with chronic HCV, the annual incidence rate of HCC appeared to increase as the follow-up period progressed. According to the results of the current study, the factors that independently affected the development of HCC were age, habitual heavy drinking, and histologic staging.

摘要

背景

肝细胞癌(HCC)在丙型肝炎病毒(HCV)相关慢性肝病患者中比在乙型肝炎病毒相关疾病患者中更常见。评估影响HCC发生的因素很重要。

方法

对慢性HCV患者进行了一项回顾性长期随访研究。共有153例在1981年6月至1990年11月期间经肝活检诊断为慢性HCV(伴或不伴肝硬化)的患者纳入长期随访研究(平均99.4个月),并检查了HCC的累积发病率及影响HCC出现的因素。

结果

5年累积发病率为9%,10年累积发病率为23%,15年累积发病率为42%。随着随访期延长,年发病率上升。作者选取了10个变量并研究它们对HCC发病率的影响,包括年龄、性别、习惯性大量饮酒、乙肝病毒表面抗原抗体阳性、随访期间干扰素(IFN)治疗、随访期间血清丙氨酸氨基转移酶的最高和最低水平、组织学分期、分级以及肝细胞的不规则再生。根据多变量Cox比例风险回归分析,10个变量中,年龄(>50岁)、习惯性大量饮酒和组织学分期被确定为独立危险因素。IFN治疗本身未被发现是影响HCC出现的独立因素。

结论

在慢性HCV患者中,随着随访期延长,HCC的年发病率似乎上升。根据本研究结果,独立影响HCC发生的因素是年龄、习惯性大量饮酒和组织学分期。

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