Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Am J Gastroenterol. 2011 May;106(5):899-906. doi: 10.1038/ajg.2010.477. Epub 2010 Dec 21.
We conducted a retrospective cohort study in cirrhotic patients to understand (i) the risk of developing hepatocellular carcinoma (HCC) after an initial negative screening computed tomography (CT) scan and its relationship with underlying etiology and (ii) the risk of extrahepatic cancers (EHCs).
Our cohort consisted of 952 cirrhotics who had at least one contrast-enhanced CT scan over a 5-year period from 1997 to 2002. We assessed their risk of HCC and EHC until the study closure (31 December 2007). Using data from the Indiana State Cancer Registry (ISCR), standardized incidence ratios (SIRs) were calculated for HCC and EHC.
The cohort's follow-up was 4.7±3.0 years. The frequency of HCC at baseline and during follow-up was 6.9 and 7.2%, respectively. The 1-, 3-, and 5-year HCC incidence after an initial negative CT scan was 1.2, 4.4, and 7.8%, respectively. The 1-, 3-, and 5-year EHC incidence was 2.2, 4.5, and 6.8%, respectively. The most common EHCs were breast, lung, and lymphoma. Incidence of both HCC (P=0.016) and EHC (P=0.004) varied significantly by the etiology of underlying cirrhosis. The SIRs for HCC and EHC were 186 (95% confidence interval (CI) 140-238) and 1.83 (95% CI 1.36-2.36), respectively. Compared with adjusted ISCR data, cirrhosis due to alcohol (SIR 2.73, 95% CI 1.14-4.33) but not other etiologies had significantly higher incidence of EHC.
This study furthers our understanding of HCC and EHC risk in cirrhosis. If confirmed by other studies, these data will assist in developing optimal strategies for monitoring of cancer in individuals with cirrhosis.
我们对肝硬化患者进行了一项回顾性队列研究，以了解（i）初次阴性 CT 扫描后发生肝细胞癌（HCC）的风险及其与潜在病因的关系，以及（ii）肝外癌症（EHC）的风险。
我们的队列包括 952 名肝硬化患者，他们在 1997 年至 2002 年期间至少进行了一次增强 CT 扫描。我们评估了他们在研究结束（2007 年 12 月 31 日）之前发生 HCC 和 EHC 的风险。使用印第安纳州癌症登记处（ISCR）的数据，计算 HCC 和 EHC 的标准化发病比（SIR）。
该队列的随访时间为 4.7±3.0 年。基线时和随访期间 HCC 的发生率分别为 6.9%和 7.2%。初次阴性 CT 扫描后 1、3 和 5 年的 HCC 发生率分别为 1.2%、4.4%和 7.8%。1、3 和 5 年的 EHC 发生率分别为 2.2%、4.5%和 6.8%。最常见的 EHC 是乳腺癌、肺癌和淋巴瘤。HCC（P=0.016）和 EHC（P=0.004）的发生率均因潜在肝硬化的病因而异。HCC 和 EHC 的 SIR 分别为 186（95%置信区间[CI] 140-238）和 1.83（95% CI 1.36-2.36）。与调整后的 ISCR 数据相比，酒精性肝硬化（SIR 2.73，95% CI 1.14-4.33）而非其他病因的 EHC 发生率显著升高。
本研究进一步了解了肝硬化患者 HCC 和 EHC 的风险。如果其他研究证实这些数据，将有助于制定监测肝硬化患者癌症的最佳策略。
