Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
J Gastroenterol Hepatol. 2013 Dec;28 Suppl 4:88-92. doi: 10.1111/jgh.12239.
In Japan, there has been a gradual increase in cases of non-viral chronic liver diseases, including non-alcoholic fatty liver disease (NAFLD), occurring with hepatocellular carcinoma (HCC). First, a national survey investigating the etiology of HCC in Japan was performed. Among HCCs based on non-viral disease, alcoholic liver disease with HCC accounted for 7.2% of all HCCs, followed by chronic liver disease of unknown etiology with HCC (5.1%) and NAFLD with HCC (2.0%). The clinical characteristics of these three HCC groups were clearly different. In our second analysis, the HCC development rates among liver cirrhosis with NAFLD, alcoholic cirrhosis, and cirrhosis with hepatitis C virus (HCV) were compared. HCC development rates were 11.3%/5 years in NAFLD cirrhosis, 30.5%/5 years in HCV cirrhosis, and 12.5%/5 years in alcoholic cirrhosis, suggesting that the hepatocarcinogenesis in NAFLD and alcoholic liver disease were similar but were lower than that in HCV. Using Cox hazards analysis, older age, higher serum γ-glutamyl transpeptidase level, and higher Child-Pugh score as risk factors of HCC were identified. Finally, clinical data of NAFLD-HCC with the data for HCC with HCV (HCV-HCC) were compared. The percentage of NAFLD-HCC patients with des-gamma-carboxy prothrombin-positive was higher than that with α-fetoprotein-positive. The 5-year survival and recurrence rates for NAFLD-HCC were almost similar to those for HCV-HCC. In Asian countries, the prevalence of NAFLD is increasing. Therefore, elucidating the pathogenesis and clinical features of HCC in patients with NAFLD is indeed an urgent problem.
在日本，非病毒性慢性肝病（包括非酒精性脂肪性肝病（NAFLD））合并肝细胞癌（HCC）的病例逐渐增多。首先，我们进行了一项全国性调查，以研究日本 HCC 的病因。在基于非病毒性疾病的 HCC 中，酒精性肝病合并 HCC 占所有 HCC 的 7.2%，其次是病因不明的慢性肝病合并 HCC（5.1%）和 NAFLD 合并 HCC（2.0%）。这三组 HCC 的临床特征明显不同。在我们的第二项分析中，比较了伴有 NAFLD、酒精性肝硬化和丙型肝炎病毒（HCV）肝硬化的肝硬化患者的 HCC 发展率。NAFLD 肝硬化的 HCC 发展率为 11.3%/5 年，HCV 肝硬化为 30.5%/5 年，酒精性肝硬化为 12.5%/5 年，提示 NAFLD 和酒精性肝病的肝癌发生机制相似，但低于 HCV。使用 Cox 风险分析，确定了年龄较大、血清 γ-谷氨酰转肽酶水平较高和 Child-Pugh 评分较高是 HCC 的危险因素。最后，比较了伴有 NAFLD 的 HCC（NAFLD-HCC）和伴有 HCV 的 HCC（HCV-HCC）的临床数据。NAFLD-HCC 患者中 des-gamma-羧基凝血酶原阳性的比例高于 AFP 阳性的患者。NAFLD-HCC 的 5 年生存率和复发率与 HCV-HCC 几乎相似。在亚洲国家，NAFLD 的患病率正在增加。因此，阐明 NAFLD 患者 HCC 的发病机制和临床特征确实是一个紧迫的问题。
