Hashizume Hiroaki, Sato Ken, Takagi Hitoshi, Hirokawa Tomoyuki, Kojima Akira, Sohara Naondo, Kakizaki Satoru, Mochida Yasushi, Shimura Tatsuo, Sunose Yutaka, Ohwada Susumu, Mori Masatomo
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Eur J Gastroenterol Hepatol. 2007 Oct;19(10):827-34. doi: 10.1097/MEG.0b013e3282748ef2.
Nine patients with hepatocellular carcinoma (HCC) in nonalcoholic steatohepatitis (NASH) (six men and three women, median age 71.5 years) and one patient with intrahepatic cholangiocarcinoma (ICC), a 50-year-old man, in NASH are described. Most patients were associated with obesity, diabetes, hypertension, hypercholesterolemia, or hypertriglyceridemia. Seven patients showed insulin resistance and hyperinsulinemia. All patients except one met the criteria for metabolic syndrome. An HCC or ICC diagnosis was confirmed by tumor biopsy, surgery or autopsy except in two patients, who were diagnosed by computed tomography or hepatic angiography. The underlying liver disease was liver cirrhosis in six patients and chronic liver disease including mild hepatic fibrosis in four patients. The treatment of liver cancers consisted of surgery, radio-frequency ablation (RFA), transcatheter arterial embolization and transcatheter arterial infusion. Although the follow-up period was relatively short (median 27.5 months, average 32.1 months), all postoperative and post-RFA patients have not had a recurrence of HCC to date, except for one patient who had a palliative operation with intra-arterial infusion of anticancer drugs through an implanted reservoir port. Older age and liver cirrhosis are considered risk factors for HCC in NASH, and regular screening of these patients is necessary. Diabetes may contribute to the development of ICC in NASH. Curative therapy (surgery or RFA) and weight loss by the active therapeutic intervention (nutritional care and exercise therapy) after curative therapy may help us improve the prognosis of HCC in NASH.
本文描述了9例非酒精性脂肪性肝炎（NASH）合并肝细胞癌（HCC）的患者（6例男性，3例女性，中位年龄71.5岁）以及1例NASH合并肝内胆管癌（ICC）的患者（1名50岁男性）。大多数患者伴有肥胖、糖尿病、高血压、高胆固醇血症或高甘油三酯血症。7例患者表现出胰岛素抵抗和高胰岛素血症。除1例患者外，所有患者均符合代谢综合征的标准。除2例患者通过计算机断层扫描或肝血管造影确诊外，其余患者均通过肿瘤活检、手术或尸检确诊HCC或ICC。6例患者的基础肝病为肝硬化，4例患者为慢性肝病，包括轻度肝纤维化。肝癌的治疗方法包括手术、射频消融（RFA）、经导管动脉栓塞和经导管动脉灌注。尽管随访期相对较短（中位27.5个月，平均32.1个月），但除1例通过植入储液端口进行动脉内抗癌药物灌注的姑息手术患者外，所有术后和RFA术后患者至今均未出现HCC复发。年龄较大和肝硬化被认为是NASH患者发生HCC的危险因素，对这些患者进行定期筛查很有必要。糖尿病可能促使NASH患者发生ICC。根治性治疗（手术或RFA）以及根治性治疗后通过积极的治疗干预（营养护理和运动疗法）减轻体重，可能有助于改善NASH患者HCC的预后。
