First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Internal Medicine 1, University of Bonn, Bonn, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Clin Gastroenterol Hepatol. 2014 Oct;12(10):1733-8. doi: 10.1016/j.cgh.2014.02.008. Epub 2014 Feb 12.
BACKGROUND & AIMS: Primary sclerosing cholangitis (PSC) is associated with an increased risk of hepatobiliary malignancies. However, little is known about the incidence of hepatocellular carcinoma (HCC) among patients with PSC; current recommendations on screening these patients for HCC are conflicting. We investigated the risk of HCC in patients with PSC with cirrhosis.
We performed a retrospective study of patients with well-defined PSC from 2 large-volume tertiary care centers in Germany; data were collected from periods of up to 33 years. Liver cirrhosis was based on histology results or the presence of ascites, esophageal varices, or transient elastography values greater than 14 kPa. Statistical analysis was performed using the Kaplan-Meier method and the Cox proportional hazard model. Data from 509 patients (67% male), with a total of 4202 patients-years, were included in the final analysis.
We identified 119 patients with cirrhosis. During 292 patient-years, none of these patients developed HCC. Most HCCs were identified incidentally at the time of liver transplantation. We therefore reviewed data on liver explants from 140 patients who underwent transplantation; none were found to contain HCC. In contrast to the low numbers of HCCs among patients with PSC, 35 patients developed cholangiocarcinoma, 3 patients developed gallbladder cancer, and 9 patients developed colorectal cancer.
Based on a retrospective analysis of more than 500 patients with PSC, we confirm their high risk for hepatobiliary malignancies. However, the risk of HCC, even among patients with cirrhosis, seems to be low--regular HCC surveillance may not be warranted.
原发性硬化性胆管炎（PSC）与肝胆恶性肿瘤的风险增加相关。然而，对于 PSC 患者中肝细胞癌（HCC）的发病率知之甚少；目前针对这些患者 HCC 的筛查建议存在争议。我们研究了伴有肝硬化的 PSC 患者发生 HCC 的风险。
我们对来自德国 2 家大型三级护理中心的明确诊断为 PSC 的患者进行了回顾性研究；数据收集时间长达 33 年。肝硬化基于组织学结果或腹水、食管静脉曲张或瞬时弹性成像值大于 14kPa 的存在来确定。使用 Kaplan-Meier 方法和 Cox 比例风险模型进行统计分析。最终分析纳入了 509 例患者（67%为男性），共 4202 人年的数据。
我们确定了 119 例伴有肝硬化的患者。在 292 人年期间，这些患者均未发生 HCC。大多数 HCC 是在进行肝移植时偶然发现的。因此，我们回顾了 140 例接受移植的患者的肝移植标本数据；未发现 HCC。与 PSC 患者 HCC 数量低相比，有 35 例患者发生胆管癌，3 例患者发生胆囊癌，9 例患者发生结直肠癌。
基于对超过 500 例 PSC 患者的回顾性分析，我们证实了他们发生肝胆恶性肿瘤的高风险。然而，即使在伴有肝硬化的患者中，HCC 的风险似乎也较低——可能不需要常规 HCC 监测。
