The Dumont-UCLA Liver Cancer Center, Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
J Clin Gastroenterol. 2010 Mar;44(3):e63-70. doi: 10.1097/MCG.0b013e3181b4b68b.
BACKGROUND/RATIONALE: Hepatocellular carcinoma (HCC) is a common malignancy in Asians and is related to the high incidence of chronic viral hepatitis in this ethnic population. The aims of this study were to examine the tumor characteristics and liver disease status in HCC patients of Asian ancestry and determine their survival after treatments for HCC.
Between September 2000 and December 2007, 278 patients, mean age 61.5 years, presented with HCC to the University of California Los Angeles (UCLA) Liver Cancer Center. Hepatitis B (HBV) infection was detected in up to 68% of Chinese, Korean, and Vietnamese patients, whereas 60% of Japanese patients had Hepatitis C (HCV) infection. Compared with HCC patients who presented with symptoms, those detected by surveillance had more tumors within the Milan and University of California, San Francisco (UCSF) criteria and more patients in Child-Turcotte-Pugh class A. On the basis of a predefined UCLA treatment algorithm, 83% of patients received surgical and/or loco-regional therapies. Compared with other treatments, orthotopic liver transplantation (OLT), and radiofrequency ablation had the highest overall patient survival (P<0.0001) and OLT has the highest disease free survival rates (P<0.0001). Independent baseline predictors for: (1) patient survival were HBV [hazard ratio (HR) 0.62, P=0.005], UCSF criteria (HR 0.46, P<0.0001), Child Turcotte Pugh class A (HR 0.57, P=0.005), alphafetoprotein per log10 increase (HR 1.26, P=0.0012), and alkaline phosphatase per log10 increase (HR 2.32, P=0.02); and for (2) disease free survival were UCSF criteria (HR 0.66 P=0.007), aspartate aminotransferase per log10 increase (HR 1.50, P=0.04), and age per year increase (HR=1.02, P=0.04). The 4 Asian subgroups had similar survival rates.
HBV and Hepatitis C were associated with over 90% of HCC cases in Asian Americans. HCC detected by surveillance identified more patients eligible for surgical and loco-regional therapies, which improved the overall and disease free survival.
背景/理由：肝细胞癌（HCC）是亚洲地区常见的恶性肿瘤，与该地区慢性病毒性肝炎高发有关。本研究旨在探讨亚裔 HCC 患者的肿瘤特征和肝脏疾病状况，并确定他们接受 HCC 治疗后的生存情况。
2000 年 9 月至 2007 年 12 月，278 例平均年龄 61.5 岁的 HCC 患者在加利福尼亚大学洛杉矶分校（UCLA）肝癌中心就诊。乙型肝炎病毒（HBV）感染在高达 68%的中国、韩国和越南患者中被检测到，而 60%的日本患者患有丙型肝炎（HCV）。与出现症状的 HCC 患者相比，通过监测发现的患者符合米兰和加利福尼亚大学旧金山分校（UCSF）标准的肿瘤更多，且 Child-Turcotte-Pugh 分级 A 的患者更多。根据 UCLA 预先设定的治疗方案，83%的患者接受了手术和/或局部区域治疗。与其他治疗方法相比，原位肝移植（OLT）和射频消融术具有最高的总体患者生存率（P<0.0001），而 OLT 具有最高的无疾病生存率（P<0.0001）。患者生存的独立基线预测因素为：（1）HBV[风险比（HR）0.62，P=0.005]、UCSF 标准（HR 0.46，P<0.0001）、Child-Turcotte-Pugh 分级 A（HR 0.57，P=0.005）、甲胎蛋白每对数增加（HR 1.26，P=0.0012）和碱性磷酸酶每对数增加（HR 2.32，P=0.02）；以及（2）无疾病生存率的是 UCSF 标准（HR 0.66，P=0.007）、天冬氨酸转氨酶每对数增加（HR 1.50，P=0.04）和年龄每年增加（HR=1.02，P=0.04）。四个亚洲亚组的生存率相似。
HBV 和丙型肝炎导致 90%以上的亚裔美国人患有 HCC。通过监测发现的 HCC 患者有更多符合手术和局部区域治疗条件的患者，这提高了总体生存率和无疾病生存率。
