非酒精性脂肪性肝炎和酒精性肝病引起的肝硬化中的肝内和肝外恶性肿瘤。
Hepatic and extrahepatic malignancies in cirrhosis caused by nonalcoholic steatohepatitis and alcoholic liver disease.
机构信息
Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
出版信息
Alcohol Clin Exp Res. 2013 Jan;37 Suppl 1:E247-52. doi: 10.1111/j.1530-0277.2012.01900.x.
BACKGROUND
To clarify the carcinogenic factors associated with steatohepatitis, we investigated the characteristic features of hepatic and extrahepatic malignancies in patients with cirrhotic nonalcoholic steatohepatitis (NASH-LC) and cirrhotic alcoholic liver disease (ALD-LC).
METHODS
A total of 72 patients with NASH-LC and 85 with ALD-LC (both biopsy-proven steatohepatitis without hepatocellular carcinoma [HCC]) were assessed with regard to the development of hepatic and extrahepatic malignancies. Risk factors for HCC were analyzed.
RESULTS
During follow-up, 10 NASH-LC patients and 6 ALD-LC patients developed HCC. The 5-year HCC development rate was similar for these 2 groups, being 10.5% in the NASH-LC group and 12.3% in the ALD-LC group. After adjusting for age and gender, the HCC development rates were also similar. Risk factors for HCC in the NASH-LC group were older age, higher γ-GTP level, and higher Child-Pugh score as determined by Cox hazards analysis. Regarding risk factors in the ALD-LC group, no risk factor was found by Cox hazards analysis, although diabetes mellitus led to a significantly higher HCC rate by log-rank test (p = 0.013). Regarding extrahepatic cancer, only 1 NASH-LC patient (1.4%) developed endometrial cancer. In contrast, 7 ALD-LC patients (8.2%) had other cancers (p = 0.052).
CONCLUSIONS
Comparison between NASH-LC and ALD-LC revealed similar HCC development curves. However, the risk factors for HCC and extrahepatic malignancies differed between the 2 diseases. In ALD-LC, the incidences of HCC and extrahepatic cancer are similar. When treating LC patients with NASH or ALD, the risk factors and extrahepatic malignancies associated with ALD-LC should be assessed.
背景
为了阐明与脂肪性肝炎相关的致癌因素，我们研究了肝硬化非酒精性脂肪性肝炎（NASH-LC）和肝硬化酒精性肝病（ALD-LC）患者肝内和肝外恶性肿瘤的特征。
方法
共评估了 72 例 NASH-LC 患者和 85 例 ALD-LC 患者（均为经活检证实的非 HCC 脂肪性肝炎）肝内和肝外恶性肿瘤的发生情况。分析了 HCC 的危险因素。
结果
在随访期间，10 例 NASH-LC 患者和 6 例 ALD-LC 患者发生 HCC。这两组的 5 年 HCC 发生率相似，NASH-LC 组为 10.5%，ALD-LC 组为 12.3%。经年龄和性别调整后，HCC 的发生率也相似。NASH-LC 组 HCC 的危险因素为年龄较大、γ-GTP 水平较高和 Cox 风险分析确定的 Child-Pugh 评分较高。ALD-LC 组的危险因素，Cox 风险分析未发现任何危险因素，但 Log-rank 检验发现糖尿病（p=0.013）导致 HCC 发生率显著升高。关于肝外癌症，只有 1 例 NASH-LC 患者（1.4%）发生子宫内膜癌。相比之下，7 例 ALD-LC 患者（8.2%）有其他癌症（p=0.052）。
结论
NASH-LC 和 ALD-LC 之间的比较显示出相似的 HCC 发展曲线。然而，这两种疾病的 HCC 和肝外恶性肿瘤的危险因素不同。在 ALD-LC 中，HCC 和肝外癌症的发生率相似。在治疗 NASH 或 ALD 引起的 LC 患者时，应评估与 ALD-LC 相关的危险因素和肝外恶性肿瘤。
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