Chen Wen-Chi, Lo Gin-Ho, Lai Kwok-Hung, Cheng Jin-Shiung, Hsu Ping-I, Lin Chiun-Ku
Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, ROC.
J Chin Med Assoc. 2004 Nov;67(11):557-64.
Endoscopic and pharmacological treatments significantly reduce recurrent esophageal variceal bleeding and improve the prognosis of cirrhotic patients. This study was aimed to evaluate the incidence, risk factors, treatment and prognosis of hepatocellular carcinoma after esophageal variceal bleeding.
Patients with esophageal variceal bleeding underwent endoscopic or pharmacological treatments to arrest acute bleeding or prevent rebleeding. Concurrently, patients were followed by periodic serum alpha-fetoprotein examinations and ultrasonography, aiming at early detection and possible treatment of hepatocellular carcinoma.
Hepatocellular carcinoma developed in 79 of 370 patients (21.4%) during the 10-year follow-up. The cumulative incidence of hepatocellular carcinoma was 21.1% at the end of the third year, 39.3% at the end of the fifth year and 53.0% at the end of the tenth year. Small tumors (< or = 3 cm) were found in 64 patients (81.0%, monofocal tumors in 46 patients). Age, hepatitis B virus, hepatitis C virus, and alpha-fetoprotein level > 20 ng/mL were factors associated with the risk of hepatocellular carcinoma development by multivariate analysis using Cox regression. Tumors were actively treated in 37 of 49 Child-Pugh A and B patients (75.5%) and 2 of 30 Child-Pugh C patients (6.7%). The median survival of all patients was 2.5 (range, 0.5 to 10.0) years. Development of hepatocellular carcinoma and serum bilirubin level were significantly associated with mortality in Child-Pugh A and B patients.
Patients with esophageal variceal bleeding had a high risk of developing hepatocellular carcinoma. Surveillance on hepatocellular carcinoma could detect most tumors with small size. Hepatocellular carcinoma had an adverse impact on the survival of patients without advanced cirrhosis.
内镜治疗和药物治疗可显著降低食管静脉曲张再出血率，改善肝硬化患者的预后。本研究旨在评估食管静脉曲张出血后肝细胞癌的发生率、危险因素、治疗及预后。
食管静脉曲张出血患者接受内镜或药物治疗以控制急性出血或预防再出血。同时，对患者进行定期血清甲胎蛋白检查和超声检查，旨在早期发现并可能治疗肝细胞癌。
在10年随访期间，370例患者中有79例（21.4%）发生肝细胞癌。肝细胞癌的累积发生率在第三年末为21.1%，第五年末为39.3%，第十年末为53.0%。64例患者（81.0%）发现小肿瘤（≤3 cm），其中46例为单发病灶。采用Cox回归多因素分析显示，年龄、乙型肝炎病毒、丙型肝炎病毒及甲胎蛋白水平>20 ng/mL是肝细胞癌发生风险的相关因素。49例Child-Pugh A级和B级患者中有37例（75.5%）及30例Child-Pugh C级患者中有2例（6.7%）的肿瘤得到积极治疗。所有患者的中位生存期为2.5年（范围0.5至10.0年）。Child-Pugh A级和B级患者中，肝细胞癌的发生及血清胆红素水平与死亡率显著相关。
食管静脉曲张出血患者发生肝细胞癌的风险较高。对肝细胞癌的监测可发现大多数小肿瘤。肝细胞癌对无晚期肝硬化患者的生存有不利影响。
