Department of Medicine, University of Minnesota, Hennepin County Medical Center, Minneapolis, MN, USA.
Departamento de Gastroenterologia, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina.
Liver Int. 2018 Jan;38(1):136-143. doi: 10.1111/liv.13502. Epub 2017 Jul 18.
BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death worldwide. Most studies addressing the epidemiology of HCC originate from developed countries. This study reports the preliminary findings of a multinational approach to characterize HCC in South America.
We evaluated 1336 HCC patients seen at 14 centres in six South American countries using a retrospective study design with participating centres completing a template chart of patient characteristics. The diagnosis of HCC was made radiographically or histologically for all cases according to institutional standards. Methodology of surveillance for each centre was following AASLD or EASL recommendations.
Sixty-eight percent of individuals were male with a median age of 64 years at time of diagnosis. The most common risk factor for HCC was hepatitis C infection (HCV, 48%), followed by alcoholic cirrhosis (22%), Hepatitis B infection (HBV, 14%) and NAFLD (9%). We found that among individuals with HBV-related HCC, 38% were diagnosed before age 50. The most commonly provided therapy was transarterial chemoembolization (35% of HCCs) with few individuals being considered for liver transplant (<20%). Only 47% of HCCs were diagnosed during surveillance, and there was no difference in age of diagnosis between those diagnosed incidentally vs by surveillance. Nonetheless, being diagnosed during surveillance was associated with improved overall survival (P = .01).
Our study represents the largest cohort to date reporting characteristics and outcomes of HCC across South America. We found an important number of HCCs diagnosed outside of surveillance programmes, with associated increased mortality in those patients.
肝细胞癌（HCC）是全球癌症相关死亡的第二大主要原因。大多数研究肝癌的流行病学起源于发达国家。本研究报告了一种多国家方法的初步结果，用于描述南美洲的 HCC。
我们采用回顾性研究设计，使用模板图表评估了来自六个南美国家的 14 个中心的 1336 名 HCC 患者。所有病例均根据机构标准通过影像学或组织学诊断 HCC。每个中心的监测方法遵循 AASLD 或 EASL 的建议。
68%的患者为男性，中位诊断年龄为 64 岁。HCC 的最常见危险因素是丙型肝炎感染（HCV，48%），其次是酒精性肝硬化（22%）、乙型肝炎感染（HBV，14%）和非酒精性脂肪性肝病（NAFLD，9%）。我们发现，在 HBV 相关 HCC 患者中，38%在 50 岁之前被诊断出。最常提供的治疗方法是经动脉化疗栓塞（TACE，35%的 HCC），很少有患者被考虑进行肝移植（<20%）。只有 47%的 HCC 是在监测期间诊断出的，且在监测中诊断与偶然诊断的患者年龄无差异。尽管如此，在监测中诊断与改善的总体生存率相关（P=0.01）。
我们的研究代表了迄今为止报告南美洲 HCC 特征和结局的最大队列。我们发现了大量在监测计划之外诊断的 HCC，这些患者的死亡率更高。
