Department of Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
Dig Dis Sci. 2012 Dec;57(12):3265-70. doi: 10.1007/s10620-012-2260-y. Epub 2012 Jun 14.
There is limited literature on hepatocellular carcinoma (HCC) in patients with chronic hepatitis C virus (HCV) infection in the absence of cirrhosis.
To investigate the relationship between HCV and HCC in the absence of cirrhosis and to characterize patients with HCV infection presenting with HCC in the absence of cirrhosis.
We identified all adult patients with histological confirmation of HCC between 1994 and 2007 (404 patients). A case-control design (four controls for each case with non-cirrhotic HCC) was chosen to compare characteristics and survival of HCV in HCC patients without (cases) and with (controls) cirrhosis. Conditional logistic regression analysis was used to identify factors independently associated with HCV in non-cirrhotic HCC.
Eighty-seven patients with non-cirrhotic HCC were identified, six (7 %) had HCV infection in comparison with 107 of 317 (55.7 %) with cirrhotic HCC (P < 0.001). Compared with the HCV-associated HCC cirrhotic group, patients with HCV-associated HCC in the absence of cirrhosis were more likely to present with a single nodule (100 vs. 66.7 %), larger nodule size (>5 cm) (100 vs. 16.7 %), and macrovascular invasion (66.7 vs. 17.4 %) at time of diagnosis. Four of six patients with HCV-associated HCC in the absence of cirrhosis where alive at three years (all had resection), which was better survival than for HCC arising in cirrhotic livers of HCV-infected individuals (66.7 vs. 39.1 %).
We found that HCV is responsible for a small minority of non-cirrhotic HCC cases representing an uncommon and poorly defined subgroup of HCC.
在没有肝硬化的情况下，慢性丙型肝炎病毒（HCV）感染患者的肝细胞癌（HCC）文献有限。
研究无肝硬化的 HCV 与 HCC 之间的关系，并对无肝硬化的 HCV 感染患者 HCC 患者的特征进行描述。
我们确定了 1994 年至 2007 年期间所有经组织学证实的 HCC 成年患者（404 例）。选择病例对照设计（每个无肝硬化 HCC 病例 4 个对照），比较无肝硬化 HCC 患者（病例）和肝硬化患者（对照）的 HCV 特征和生存情况。采用条件逻辑回归分析确定与非肝硬化 HCC 中 HCV 独立相关的因素。
确定了 87 例非肝硬化 HCC 患者，其中 6 例（7%）患有 HCV 感染，而 317 例肝硬化 HCC 患者中有 107 例（55.7%）患有 HCV 感染（P<0.001）。与 HCV 相关的肝硬化 HCC 组相比，无肝硬化 HCC 患者中更有可能表现为单个结节（100%比 66.7%）、更大的结节大小（>5cm）（100%比 16.7%）和大血管侵犯（66.7%比 17.4%）。在诊断时，无肝硬化 HCV 相关 HCC 患者中有 4 例（66.7%）仍存活，存活时间为 3 年（均接受了切除术），这比 HCV 感染的肝硬化肝脏中 HCC 患者的生存率（66.7%比 39.1%）要好。
我们发现 HCV 导致一小部分非肝硬化 HCC 病例，代表了 HCC 一个罕见且定义不明确的亚组。
