Kuper H, Ye W, Broomé U, Romelsjö A, Mucci L A, Ekbom A, Adami H O, Trichopoulos D, Nyrén O
Department of Epidemiology and Public Health, University College London, London, UK.
Hepatology. 2001 Oct;34(4 Pt 1):714-8. doi: 10.1053/jhep.2001.28233.
No prospective study has analyzed simultaneously chronic viral hepatitis and alcoholism as risk factors for liver carcinogenesis, while taking into consideration the role of cirrhosis. Nor has the risk for hepatocellular carcinoma among patients with chronic viral hepatitis been prospectively evaluated in a low-risk Western population. Last, the relationship between hepatocellular carcinoma risk factors and bile duct cancer remains to be clarified. We analyzed prospectively the risk for primary liver and extrahepatic biliary tract cancer among 186,395 patients hospitalized with either chronic viral hepatitis, alcoholism, cirrhosis, or any combination of these conditions through linkages between national Swedish registers. Compared with the general population, the relative risk of hepatocellular carcinoma was 34.4 for chronic viral hepatitis alone, 2.4 for alcoholism alone, and 40.7 for cirrhosis alone. Among patients with combinations of these risk conditions, the relative risk of hepatocellular carcinoma was 27.3 for chronic viral hepatitis and alcoholism, 118.5 for chronic viral hepatitis and cirrhosis, 22.4 for alcoholism and cirrhosis, and 171.4 for all 3 conditions. We found limited evidence for an excess risk of intrahepatic, but not for extrahepatic, biliary duct cancer. Cirrhosis amplifies the risk of hepatocellular carcinoma among patients with chronic viral hepatitis, but it is not a prerequisite for liver carcinogenesis. In contrast, cirrhosis may be a necessary intermediate for the development of hepatocellular carcinoma among alcoholics.
尚无前瞻性研究同时分析慢性病毒性肝炎和酗酒作为肝癌发生风险因素的情况，同时考虑肝硬化的作用。在低风险的西方人群中，也没有对慢性病毒性肝炎患者发生肝细胞癌的风险进行前瞻性评估。最后，肝癌风险因素与胆管癌之间的关系仍有待阐明。我们通过瑞典国家登记系统之间的关联，对186,395例因慢性病毒性肝炎、酗酒、肝硬化或这些情况的任何组合而住院的患者发生原发性肝癌和肝外胆管癌的风险进行了前瞻性分析。与普通人群相比，仅慢性病毒性肝炎患者发生肝细胞癌的相对风险为34.4，仅酗酒患者为2.4，仅肝硬化患者为40.7。在这些风险状况组合的患者中，慢性病毒性肝炎和酗酒患者发生肝细胞癌的相对风险为27.3，慢性病毒性肝炎和肝硬化患者为118.5，酗酒和肝硬化患者为22.4，三种情况并存的患者为171.4。我们发现肝内胆管癌存在额外风险的证据有限，而肝外胆管癌则没有。肝硬化会增加慢性病毒性肝炎患者发生肝细胞癌的风险，但它不是肝癌发生的先决条件。相比之下，肝硬化可能是酗酒者发生肝细胞癌的必要中间环节。
