Marot Astrid, Henrion Jean, Knebel Jean-François, Moreno Christophe, Deltenre Pierre
Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland.
Division of Gastroenterology and Hepatology, Centres hospitaliers de Jolimont, Haine-Saint-Paul, Belgium.
PLoS One. 2017 Oct 27;12(10):e0186715. doi: 10.1371/journal.pone.0186715. eCollection 2017.
Cirrhosis is a heterogeneous clinical condition that includes patients at wide-ranging stages of severity. The role of the underlying liver disease on patient prognosis remains unclear.
To assess the impact of the underlying liver disease on the occurrence of hepatocellular carcinoma (HCC) and death.
Data related to the occurrence of HCC and death were collected during a 21-year period among patients with cirrhosis related to alcoholic liver disease (ALD) (n = 529), chronic hepatitis C virus (HCV) infection (n = 145) or non-alcoholic fatty liver disease (NAFLD) (n = 78).
At inclusion, ALD patients were younger than HCV and NAFLD patients (56 vs. 67 vs. 63 years; p<0.001) and had worse liver function (percent of patients with Child-Pugh stages B or C: 48% vs. 8% vs. 17%; p<0.001). During follow-up, 85 patients developed HCC and 379 died. The 10-year cumulative incidence rate of HCC was lower in ALD patients than in HCV and NAFLD patients (8.4% vs. 22.0% vs. 23.7%; p<0.001). The 10-year cumulative incidence rates of mortality were not statistically different between ALD, HCV and NAFLD patients (58.1% vs. 47.7% vs. 49.9%; p = 0.078). Alcohol abstinence and viral eradication were associated with reduced mortality among ALD and HCV patients, respectively. In multivariate analyses, ALD was associated with a reduced risk of HCC (0.39; 95% CI, 0.20-0.76; p = 0.005) but with a higher risk of mortality (1.53; 95% CI, 1.20-1.95; p<0.001). ALD patients died more frequently from decompensation of cirrhosis.
Despite a lower incidence of HCC, patients with ALD-related cirrhosis have a worse outcome than those with chronic HCV infection or NAFLD-related cirrhosis.
肝硬化是一种异质性临床病症，包括处于广泛严重程度阶段的患者。潜在肝脏疾病对患者预后的作用仍不明确。
评估潜在肝脏疾病对肝细胞癌（HCC）发生及死亡的影响。
在21年期间收集了与酒精性肝病（ALD）（n = 529）、慢性丙型肝炎病毒（HCV）感染（n = 145）或非酒精性脂肪性肝病（NAFLD）（n = 78）相关的肝硬化患者中与HCC发生及死亡相关的数据。
纳入时，ALD患者比HCV和NAFLD患者年轻（56岁对67岁对63岁；p<0.001），且肝功能更差（Child-Pugh B或C期患者百分比：48%对8%对17%；p<0.001）。随访期间，85例患者发生HCC，379例死亡。ALD患者的HCC 10年累积发病率低于HCV和NAFLD患者（8.4%对22.0%对23.7%；p<0.001）。ALD、HCV和NAFLD患者的10年累积死亡率无统计学差异（58.1%对47.7%对49.9%；p = 0.078）。戒酒和病毒清除分别与ALD和HCV患者死亡率降低相关。在多变量分析中，ALD与HCC风险降低相关（0.39；95% CI，0.20 - 0.76；p = 0.005），但与死亡风险升高相关（1.53；95% CI，1.20 - 1.95；p<0.001）。ALD患者因肝硬化失代偿死亡更为频繁。
尽管ALD相关肝硬化患者的HCC发病率较低，但其预后比慢性HCV感染或NAFLD相关肝硬化患者更差。
