Cavazza Anna, Caballería Llorenç, Floreani Annarosa, Farinati Fabio, Bruguera Miquel, Caroli Diego, Parés Albert
Liver Unit, Digestive Diseases Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Hospital Clínic, IDIBAPS, Barcelona, Spain.
Hepatology. 2009 Oct;50(4):1162-8. doi: 10.1002/hep.23095.
The limited information and divergent results on the prevalence, incidence, and risk factors for hepatocellular carcinoma (HCC) in patients with primary biliary cirrhosis (PBC) may be due to the low prevalence of the disease and geographical and environmental differences. Therefore, we analyzed the incidence, prevalence, survival, and risk factors for HCC in patients with PBC from two European centers (389 from Barcelona, Spain, and 327 from Padova, Italy) followed up for 9.3 +/- 6.5 years. Gender, age, smoking habit, alcohol consumption, presence of hepatitis B surface antigen (HBsAg) or hepatitis C virus antibodies (anti-HCV), and advanced histological stage (III-IV) were evaluated as risk factors for tumor development. Twenty-four patients (13 from Barcelona and 11 from Padova) developed HCC. The prevalence of HCC was similar in Barcelona (3.34%) and Padova (3.36%). The incidence was 0.35 and 0.37 per 100 patient-years, respectively. Male gender, age >52 years, smoking habit, alcohol >40 g/day, HBsAg, and anti-HCV were not associated with HCC. Advanced histological stage was the only factor associated with the development of HCC (odds ratio [OR]: 5.80, 95% confidence interval [CI]: 2.34-14.38, P < 0.001). When analyzing the two series separately, male gender was associated with higher likelihood of HCC in Padova (OR: 8.09, 95% CI: 1.93-33.8, P < 0.01). The median survival after the diagnosis of HCC was 36 months.
The prevalence and incidence of HCC is similar in Spain and Italy and the advanced histological stage is the only risk factor associated with the development of HCC in PBC. The slight disparities observed between the two series might be explained by patient features on diagnosis of liver disease.
关于原发性胆汁性肝硬化（PBC）患者肝细胞癌（HCC）的患病率、发病率及危险因素的信息有限且结果存在分歧，这可能是由于该疾病患病率较低以及地理和环境差异所致。因此，我们分析了来自欧洲两个中心（西班牙巴塞罗那的389例和意大利帕多瓦的327例）PBC患者的HCC发病率、患病率、生存率及危险因素，随访时间为9.3±6.5年。将性别、年龄、吸烟习惯、饮酒量、乙肝表面抗原（HBsAg）或丙肝病毒抗体（抗-HCV）的存在情况以及高级组织学分期（III-IV期）评估为肿瘤发生的危险因素。24例患者（巴塞罗那13例，帕多瓦11例）发生了HCC。巴塞罗那（3.34%）和帕多瓦（3.36%）的HCC患病率相似。发病率分别为每100患者年0.35例和0.37例。男性、年龄>52岁、吸烟习惯、每日饮酒>40克、HBsAg及抗-HCV与HCC无关。高级组织学分期是与HCC发生相关的唯一因素（比值比[OR]：5.80，95%置信区间[CI]：2.34 - 14.38，P < 0.001）。分别分析两个队列时，在帕多瓦男性与HCC发生的较高可能性相关（OR：8.09，95% CI：1.93 - 33.8，P < 0.01）。HCC诊断后的中位生存期为36个月。
西班牙和意大利的HCC患病率和发病率相似，高级组织学分期是PBC中与HCC发生相关的唯一危险因素。两个队列之间观察到的细微差异可能由肝病诊断时的患者特征来解释。
