The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
Hepatopancreatobiliary Team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
J Hepatol. 2014 Jan;60(1):110-7. doi: 10.1016/j.jhep.2013.08.011. Epub 2013 Aug 23.
BACKGROUND & AIMS: Hepatocellular cancer (HCC) commonly complicates chronic liver disease and increases in incidence have been reported despite falling prevalences of viral hepatitis.
Following the introduction of centralised specialist teams to manage patients with cancer in England, we characterised the demographics of patients with HCC referred to the Newcastle-upon-Tyne Hospitals NHS Foundation Trust between 2000 and 2010. Regional HCC mortality data was from Public Health England.
HCC related mortality in the region rose 1.8 fold in 10 years, from 2.0 to 3.7 per 100,000. 632 cases were reviewed centrally, with 2-3 fold increases in referrals of patients with associated hepatitis C, alcoholic liver disease or no chronic liver disease and a >10 fold increase in HCC associated with non-alcoholic fatty liver disease (NAFLD). By 2010 NAFLD accounted for 41/118 (34.8%) cases. Irrespective of associated etiologies, metabolic risk factors were present in 78/118 (66.1%) cases in 2010, associated with regional increases in obesity and diabetes. Median overall survival was just 10.7 months. Although patients with NAFLD associated HCC were older (71.3 yr vs. 67.1 yr; p<0.001) and their cancers less often detected by surveillance, their survival was similar to other etiologies. This was attributed to significantly higher incidental presentation (38.2%) and lower prevalence of cirrhosis (77.2%).
HCC related mortality is increasing, with typical patients being elderly with metabolic risk factors. The prognosis for most of the cases is poor, but older patients with co-morbidities can do well, managed, within a specialist multidisciplinary team if their cancer is detected pre-symptomatically.
肝细胞癌（HCC）常合并慢性肝病，尽管病毒性肝炎的流行率有所下降，但发病率仍有所上升。
在英格兰引入集中管理癌症患者的专科团队后，我们对 2000 年至 2010 年间纽卡斯尔医院 NHS 基金会信托基金收治的 HCC 患者的人口统计学特征进行了描述。区域 HCC 死亡率数据来自英国公共卫生署。
该地区与 HCC 相关的死亡率在 10 年内增加了 1.8 倍，从每 10 万人 2.0 例增至 3.7 例。对 632 例病例进行了中心审查，与丙型肝炎、酒精性肝病或无慢性肝病相关的患者转诊增加了 2-3 倍，与非酒精性脂肪性肝病（NAFLD）相关的 HCC 增加了 10 倍以上。到 2010 年，NAFLD 占 118 例中的 41 例（34.8%）。无论相关病因如何，2010 年 78/118（66.1%）例存在代谢危险因素，与该地区肥胖症和糖尿病的增加有关。中位总生存期仅为 10.7 个月。尽管与 NAFLD 相关的 HCC 患者年龄较大（71.3 岁 vs. 67.1 岁；p<0.001），且其癌症较少通过监测发现，但他们的生存情况与其他病因相似。这归因于偶然表现的比例显著较高（38.2%）和肝硬化的患病率较低（77.2%）。
与 HCC 相关的死亡率正在上升，典型患者为患有代谢危险因素的老年人。大多数病例的预后较差，但如果在症状出现前检测到癌症，患有合并症的老年患者在专科多学科团队的管理下可以得到良好的治疗。
