Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
J Gastroenterol. 2010 Sep;45(9):960-7. doi: 10.1007/s00535-010-0237-1. Epub 2010 Apr 8.
This study was performed to clarify the outcomes and recurrence of hepatocellular carcinoma (HCC) in nonalcoholic steatohepatitis (NASH) in comparison with the data for HCC caused by hepatitis C virus (HCV) infection.
Data for 34 NASH patients with HCC (NASH-HCC) were analyzed prospectively, and data for 56 age- and sex-matched patients with HCC due to HCV chronic liver disease (HCV-HCC) were collected retrospectively. After the initial treatment for HCC, patients were followed regularly at least every 4 months by performing clinical examinations, serum liver function tests, monitoring alpha-fetoprotein and des-gamma-carboxy prothrombin, and utilizing various imaging modalities.
The five-year survival rate was 55.2% and the cumulative recurrence of HCC at 5 years was 69.8% in treated cases of NASH-HCC. The NASH-HCC and HCV-HCC groups showed similar survival and recurrence rates. Of the 16 NASH-HCC patients curatively treated, recurrence was detected more than 2 years after the initial treatment in 9. Three patients showed intrahepatic recurrences away from the initial HCC, and 3 patients showed a change in tumor marker production after treatment of the initial HCC. The size of the HCC and the stage of fibrosis were significant risk factors for HCC recurrence in NASH-HCC.
HCC recurrence was very high in NASH, and the HCC may be of multicentric origin, similar to HCC based on viral hepatitis. Regular screening for HCC is extremely important for NASH patients with HCC, even after curative treatment. This study confirmed that NASH-HCC has a similar course to that of HCV-HCC.
本研究旨在阐明非酒精性脂肪性肝炎（NASH）相关肝细胞癌（HCC）的结局和复发情况，并与丙型肝炎病毒（HCV）感染所致 HCC 的数据进行比较。
前瞻性分析 34 例 NASH 合并 HCC（NASH-HCC）患者的数据，并回顾性收集 56 例年龄和性别匹配的 HCV 慢性肝病合并 HCC（HCV-HCC）患者的数据。HCC 初始治疗后，通过定期进行临床检查、血清肝功能检查、监测甲胎蛋白和脱γ-羧基凝血酶原、以及利用各种影像学方法，对患者进行随访。
NASH-HCC 患者的 5 年生存率为 55.2%，5 年 HCC 累积复发率为 69.8%。NASH-HCC 和 HCV-HCC 两组的生存和复发率相似。在接受根治性治疗的 16 例 NASH-HCC 患者中，有 9 例在初始治疗后 2 年以上复发。3 例患者在初始 HCC 治疗后出现肝内复发，远离初始 HCC 部位，3 例患者在初始 HCC 治疗后肿瘤标志物产生变化。HCC 大小和纤维化分期是 NASH-HCC 患者 HCC 复发的显著危险因素。
NASH 患者 HCC 复发率很高，且 HCC 可能具有多中心起源，类似于病毒性肝炎所致 HCC。即使在根治性治疗后，对 NASH 合并 HCC 患者进行 HCC 定期筛查也非常重要。本研究证实，NASH-HCC 的病程与 HCV-HCC 相似。
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