Department of Gastroenterology and Hepatology, The Cleveland Clinic, Cleveland, OH 44195, USA.
Hepatology. 2010 Jun;51(6):1972-8. doi: 10.1002/hep.23527.
Nonalcoholic steatohepatitis (NASH) is a well-recognized cause of cirrhosis and has been increasingly associated with the development of hepatocellular carcinoma (HCC). The aims of this study were to (1) estimate the incidence of HCC in patients with NASH-related cirrhosis, (2) compare incidence in NASH-related cirrhosis with hepatitis C virus (HCV)-related cirrhosis, and (3) identify risk factors of HCC in patients with NASH-related cirrhosis compared with HCV-related cirrhosis. Adult patients with cirrhosis secondary to chronic HCV (n = 315) or NASH (n = 195) were evaluated at our hepatobiliary clinic between 2003 and 2007. To assess for HCC development, all patients were monitored using serial abdominal computed tomography and serum alpha-fetoprotein every 6 months. Kaplan-Meier analysis was performed to estimate the cumulative incidence of HCC. Descriptive statistics were computed for all factors. Univariate and multivariate Cox regression analysis were used to assess associations between HCC and factors of interest. The median follow-up was 3.2 years (25th percentile [P25], 75th percentile [P75]: 1.7, 5.7) during which 25/195 (12.8%) of NASH-cirrhotic and 64/315 (20.3 %) of HCV-cirrhotic patients developed HCC (P = 0.03). Yearly cumulative incidence of HCC was found to be 2.6% in patients with NASH-cirrhosis, compared with 4.0% in patients with HCV cirrhosis (P = 0.09). Multivariate regression analysis revealed that older age (P = 0.006) and alcohol consumption (P = 0.002) were independent variables associated with development of HCC in patients with NASH-cirrhosis. Compared with nondrinkers, patients who reported any regular alcohol consumption were at greater risk for HCC development (hazard ratio: 3.6; P25, P75: 1.5, 8.3).
Patients with NASH cirrhosis have a greatly increased risk of liver cancer. Alcohol consumption, a modifiable risk factor, appears to be the most significant factor associated with risk of HCC development in our study population.
非酒精性脂肪性肝炎（NASH）是肝硬化的一个公认病因，并与肝细胞癌（HCC）的发生日益相关。本研究的目的是：（1）评估 NASH 相关肝硬化患者 HCC 的发生率；（2）比较 NASH 相关肝硬化与丙型肝炎病毒（HCV）相关肝硬化的发生率；（3）确定与 HCV 相关肝硬化相比，NASH 相关肝硬化患者 HCC 的危险因素。在我们的肝胆诊所，于 2003 年至 2007 年期间，对因慢性 HCV（n = 315）或 NASH（n = 195）导致肝硬化的成年患者进行了评估。为了评估 HCC 的发生，所有患者均通过定期腹部 CT 和血清甲胎蛋白检测进行监测，每 6 个月一次。采用 Kaplan-Meier 分析来估计 HCC 的累积发生率。对所有因素进行描述性统计。采用单变量和多变量 Cox 回归分析来评估 HCC 与感兴趣因素之间的关系。中位随访时间为 3.2 年（25 百分位数[P25]，75 百分位数[P75]：1.7，5.7），在此期间，NASH 肝硬化患者中有 25/195（12.8%）例和 HCV 肝硬化患者中有 64/315（20.3%）例发生 HCC（P = 0.03）。发现 NASH 肝硬化患者 HCC 的年累积发生率为 2.6%，而 HCV 肝硬化患者为 4.0%（P = 0.09）。多变量回归分析显示，年龄较大（P = 0.006）和饮酒（P = 0.002）是与 NASH 肝硬化患者 HCC 发生相关的独立变量。与不饮酒者相比，有任何规律饮酒史的患者 HCC 发生风险更高（风险比：3.6；P25，P75：1.5，8.3）。
NASH 肝硬化患者发生肝癌的风险大大增加。在本研究人群中，饮酒（一种可改变的危险因素）似乎是与 HCC 发生风险相关的最重要因素。
