Arrieta Oscar, Rodriguez-Diaz Jose Luis, Rosas-Camargo Vanessa, Morales-Espinosa Daniela, Ponce de Leon Sergio, Kershenobich David, Leon-Rodriguez Eucario
Department of Medical Oncology, Instituto Nacional de Cancerologia, Tlalpan, Mexico.
Cancer. 2006 Oct 15;107(8):1852-8. doi: 10.1002/cncr.22198.
Hepatocellular carcinoma (HCC) is a malignant neoplasm associated with liver cirrhosis, with an annual incidence of 3% to 9%, which is one of the main causes of death in patients with cirrhosis. Viral hepatitis is associated with an increased risk of HCC, probably due to an inflammatory reaction. Colchicine is an antiinflammatory agent that inhibits the formation of intracellular microtubules, affecting mitosis and fibrogenesis. Diverse clinical studies have failed to demonstrate the benefit of colchicine over the progression of fibrosis in patients with liver cirrhosis; nevertheless, to the authors' knowledge there are no studies that evaluate its effect in the development of HCC.
The effect of the administration of colchicine on the development of HCC was evaluated in 186 patients with hepatitis virus-related liver cirrhosis in a retrospective cohort study. The minimum follow-up time was 3 years (median, 84 months +/- 2.8 months). One hundred sixteen patients received treatment with colchicine. The characteristics of both groups were similar.
The percentage of patients who developed HCC was significantly smaller in the colchicine group when compared with the noncolchicine group (9% vs. 29%; P = .001). On multivariate analysis, an alpha-fetoprotein level > or = 5 ng/dL (P = .03), a platelet count < 100,000 at diagnosis (P = .05), alanine aminotransferase > or = 52 IU (P = .006), and a lack of treatment with colchicine (P = .0001) were found to be associated with an earlier development of HCC. The average time for the development of HCC was 222 months +/- 15 months and 150 months +/- 12 months in the patients who received and who did not receive colchicine, respectively.
The results suggest that treatment with colchicine prevents and delays the development of HCC in patients with hepatitis virus-related cirrhosis. The protective mechanisms of colchicine over the development of HCC could be related to antiinflammatory properties and inhibition of mitosis. Prospective studies to confirm this observation with a greater number of patients and long-term follow-up may be indicated.
肝细胞癌（HCC）是一种与肝硬化相关的恶性肿瘤，年发病率为3%至9%，是肝硬化患者主要死因之一。病毒性肝炎会增加患HCC的风险，可能是由于炎症反应。秋水仙碱是一种抗炎药，可抑制细胞内微管的形成，影响有丝分裂和纤维生成。多项临床研究未能证明秋水仙碱对肝硬化患者纤维化进展有益；然而，据作者所知，尚无研究评估其对HCC发生的影响。
在一项回顾性队列研究中，对186例与肝炎病毒相关的肝硬化患者评估了秋水仙碱给药对HCC发生的影响。最短随访时间为3年（中位数，84个月±2.8个月）。116例患者接受了秋水仙碱治疗。两组患者的特征相似。
与未使用秋水仙碱的组相比，使用秋水仙碱的组发生HCC的患者百分比显著更低（9%对29%；P = 0.001）。多因素分析发现，甲胎蛋白水平≥5 ng/dL（P = 0.03）、诊断时血小板计数<100,000（P = 0.05）、丙氨酸转氨酶≥52 IU（P = 0.006）以及未使用秋水仙碱治疗（P = 0.0001）与HCC的更早发生相关。接受和未接受秋水仙碱治疗的患者发生HCC的平均时间分别为222个月±15个月和150个月±12个月。
结果表明，秋水仙碱治疗可预防和延缓肝炎病毒相关肝硬化患者HCC的发生。秋水仙碱对HCC发生的保护机制可能与抗炎特性和有丝分裂抑制有关。可能需要进行前瞻性研究，以纳入更多患者并进行长期随访来证实这一观察结果。
