Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Alcohol Clin Exp Res. 2013 Jan;37 Suppl 1:E247-52. doi: 10.1111/j.1530-0277.2012.01900.x.
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).
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.
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).
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.
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。
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。
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）。
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。
