Sun Li-Min, Lin Ming-Chia, Lin Cheng-Li, Liang Ji-An, Jeng Long-Bin, Kao Chia-Hung, Lu Chiao-Yi
From the Department of Radiation Oncology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan (L-MS); Department of Nuclear Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan (M-CL); Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan (C-LL); College of Medicine, China Medical University, Taichung, Taiwan (C-LL); Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan (J-AL, L-BJ, C-HK); Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan (J-AL); Department of Surgery, Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan (L-BJ); Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK); and Department of Radiology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan (C-YL).
Medicine (Baltimore). 2015 Dec;94(49):e2080. doi: 10.1097/MD.0000000000002080.
Alcoholic cirrhosis is generally accepted as a risk factor for hepatocellular carcinoma (HCC) development; however, little research has examined the relationship between nonalcoholic cirrhosis (NAC) and HCC. Thus, the aim of this study was to investigate whether NAC is associated with the risk of HCC and extrahepatic malignancies in Taiwan.We conducted a populated-based retrospective cohort study by using data from the Taiwan National Health Insurance (NHI) program. A total of 2109 patients with NAC were identified from the NHI database between 2000 and 2011. For a control group, 4 patients without NAC were frequency-matched with each NAC patient according to sex, age, and index year. We used Cox proportional hazards regression analysis to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) and determine the effects of NAC on cancer risk.The overall cancer risk was significantly higher in patients with NAC compared with those without NAC, and this association was consistent among age, sex, and comorbidity groups. The risk of developing HCC was remarkably high in the NAC group compared with in the control cohort (aHR = 122.7, 95% CI = 68.4-220.1); significantly higher risks of extrahepatic malignancies were observed in patients with digestive tract cancers and hematological malignancies. Further analyses stratified according sex, age, and follow-up duration revealed various patterns among the cancer types.The results indicate that patients with NAC in Taiwan have higher risks of HCC, digestive tract cancers, and hematological malignancies.
酒精性肝硬化通常被认为是肝细胞癌（HCC）发生的一个危险因素；然而，很少有研究探讨非酒精性肝硬化（NAC）与HCC之间的关系。因此，本研究的目的是调查在台湾NAC是否与HCC及肝外恶性肿瘤的风险相关。
我们利用台湾国民健康保险（NHI）计划的数据进行了一项基于人群的回顾性队列研究。2000年至2011年间，从NHI数据库中识别出总共2109例NAC患者。对于对照组，根据性别、年龄和索引年份，每例NAC患者与4例无NAC的患者进行频数匹配。我们使用Cox比例风险回归分析来计算调整后的风险比（aHRs）和95%置信区间（CIs），并确定NAC对癌症风险的影响。
与无NAC的患者相比，NAC患者的总体癌症风险显著更高，并且这种关联在年龄、性别和合并症组中是一致的。与对照组相比，NAC组发生HCC的风险非常高（aHR = 122.7，95% CI = 68.4 - 220.1）；在患有消化道癌症和血液系统恶性肿瘤的患者中，观察到肝外恶性肿瘤的风险显著更高。根据性别、年龄和随访时间进行的进一步分层分析揭示了不同癌症类型之间的各种模式。
结果表明，台湾的NAC患者发生HCC、消化道癌症和血液系统恶性肿瘤的风险更高。
