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非酒精性脂肪性肝病促进非肝硬化肝脏的肝癌发生：一项临床和病理研究。

Non-alcoholic fatty liver disease contributes to hepatocarcinogenesis in non-cirrhotic liver: a clinical and pathological study.

机构信息

Division of Gastroenterology, Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA.

出版信息

J Gastroenterol Hepatol. 2013 May;28(5):848-54. doi: 10.1111/jgh.12116.

DOI:10.1111/jgh.12116

PMID:23302015

Abstract

BACKGROUND AND AIM

Hepatocellular carcinoma (HCC) is a major complication of cirrhosis and has been increasing in incidence in recent years. Fatty liver disease is an increasingly common cause of chronic liver disease, and there have been several case reports of HCC in patients with non-cirrhotic fatty liver disease. However, there is limited data from systematic studies with histological confirmation of the presence of both the HCC and the non-cirrhotic fatty liver disease.

METHODS

We studied the occurrence of fatty liver disease and the associated demographic, clinical, and pathological characteristics of a large cohort of patients with HCC in non-cirrhotic livers. Patients with intrahepatic cholangiocarcinoma (CC) occurring in non-cirrhotic livers and diagnosed during the same time period were used as the comparison group.

RESULTS

Significant steatosis in the nontumor liver had a statistically significant association with HCC, being present in 54% (85/157) of HCC compared with 27% (32/120) of CC (P < 0.0001). Steatohepatitis was present in 15% (24/157) of HCC and 1% (2/120) of CC (P = 0.0014). Furthermore, HCC was more prevalent in cases with higher grades of steatosis. In addition, the recently described intratumoral steatohepatitic morphology of HCC (SH-HCC) was also associated with significant steatosis in nontumor liver, with significant steatosis being present in 89% with SH-HCC compared with 50% without SH-HCC (P = 0.0162). Finally, SH-HCC was increasingly more prevalent in patients with higher grades of nontumor steatosis.

CONCLUSIONS

Taken together, these findings suggest a strong association between fatty liver disease and HCC in non-cirrhotic livers.

摘要

背景与目的

肝细胞癌（HCC）是肝硬化的主要并发症，近年来其发病率一直在上升。脂肪肝疾病是慢性肝病越来越常见的原因，已有几例非肝硬化性脂肪肝疾病患者发生 HCC 的病例报告。然而，对于同时存在 HCC 和非肝硬化性脂肪肝疾病的患者，仅有有限的来自系统研究的组织学确认数据。

方法

我们研究了非肝硬化性肝脏中 HCC 患者中大量患者的脂肪肝疾病发生情况以及相关的人口统计学、临床和病理特征。在同一时期发生于非肝硬化性肝脏中的肝内胆管细胞癌（CC）患者被用作对照组。

结果

非肿瘤性肝脏中的明显脂肪变性与 HCC 具有统计学显著相关性，在 HCC 中占 54%（85/157），而在 CC 中占 27%（32/120）（P<0.0001）。在 HCC 中有 15%（24/157）的患者存在脂肪性肝炎，而在 CC 中有 1%（2/120）的患者存在脂肪性肝炎（P=0.0014）。此外，脂肪变性程度较高的病例中 HCC 更为常见。此外，最近描述的 HCC 内的脂肪性肝炎样形态（SH-HCC）也与非肿瘤性肝脏中的明显脂肪变性相关，在具有 SH-HCC 的病例中存在明显脂肪变性的比例为 89%，而在没有 SH-HCC 的病例中为 50%（P=0.0162）。最后，在非肿瘤性脂肪变性程度较高的患者中，SH-HCC 的患病率也越来越高。