Department of Gastroenterology and Hepatology, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore.
Health Services Research Unit, Division of Medicine, Singapore General Hospital, Singapore, Singapore.
Dig Dis Sci. 2019 Feb;64(2):585-590. doi: 10.1007/s10620-018-5331-x. Epub 2018 Oct 16.
Traditionally in Asia, hepatitis B (HBV) accounts for the majority of hepatocellular carcinoma (HCC), but increasingly, non-viral or nonalcoholic steatohepatitis (NASH) etiology may play a more prominent role with current socioeconomic changes. There remains a paucity in data comparing NASH-HCC to HBV-related HCC. In this study, we explored the differences in clinical characteristics between HBV- and cryptogenic-related HCC.
Patients with HCC seen in the Department of Gastroenterology and Hepatology, Singapore General Hospital were enrolled in an ongoing database since 1980. Patients with HCC attributed to HBV or cryptogenic etiology were identified. Comparison of clinical characteristics was performed between the two groups.
There were 916 HBV-HCC patients and 163 cryptogenic HCC patients, accounting for 70.9% and 12.6% of the total HCC cases (1292 patients), respectively. Out of the total cohort enrolled from 1980 to 2005, the ratio of cryptogenic to HBV patients was 1:6.7, while from 2006 to the current year, the ratio of cryptogenic to HBV patients has increased significantly to 1:3.9. Relative to patients with HBV, cryptogenic HCC patients were older (67.6 vs. 59.4 years old; p < 0.001), had lower proportion of male patients (69.9% vs. 83.8%; p < 0.001), and had higher incidence of smoking (32.2% vs. 25.8%; p = 0.008). HBV group had higher alanine transaminase (60.9 ± 85.7 U/L vs. 48.0 ± 52.1 U/L; p = 0.003), hemoglobin (12.7 ± 2.28 g/dL vs. 12.0 ± 2.46 g/dL, p < 0.001), albumin (32.9 ± 6.8 g/L vs. 31.3 ± 7.7 g/L; p = 0.007), and prothrombin time (13.2 ± 2.95 s vs. 12.7 ± 2.01 s, p = 0.023), as compared to the cryptogenic group. Cryptogenic HCC patients presented more frequently with unifocal HCC (55.2% vs. 46.5%; p = 0.002). There was no difference in the proportions of patients receiving surgical resection in both groups (23.5% in HBV group vs. 17.9% in cryptogenic group; p = 0.202). Cox regression analysis revealed no survival difference between cryptogenic-related HCC and HBV-related HCC (p = 0.367).
Temporal trends suggest that HCC attributed to HBV is on the decline, while cryptogenic- or NASH-related HCC is an emerging clinical entity. A paradigm shift in approach to screening, surveillance, and management of HCC may be required in view of the changing landscape of HCC epidemiology into an increasing non-viral etiology.
在亚洲，传统上乙型肝炎（HBV）是导致肝细胞癌（HCC）的主要原因，但随着当前社会经济的变化，非病毒性或非酒精性脂肪性肝炎（NASH）的病因可能发挥更突出的作用。目前，关于 NASH-HCC 与 HBV 相关 HCC 之间的比较数据仍然很少。在本研究中，我们探讨了 HBV 相关 HCC 和隐匿性相关 HCC 之间的临床特征差异。
自 1980 年以来，新加坡综合医院消化内科一直在进行一项正在进行的数据库研究，入组了 HCC 患者。确定了归因于 HBV 或隐匿性病因的 HCC 患者。对两组患者的临床特征进行了比较。
共有 916 例 HBV-HCC 患者和 163 例隐匿性 HCC 患者，分别占总 HCC 病例（1292 例）的 70.9%和 12.6%。1980 年至 2005 年期间，隐匿性与 HBV 患者的比例为 1:6.7，而 2006 年至当前年份，隐匿性与 HBV 患者的比例显著增加至 1:3.9。与 HBV 患者相比，隐匿性 HCC 患者年龄更大（67.6 岁 vs. 59.4 岁；p<0.001），男性患者比例更低（69.9% vs. 83.8%；p<0.001），吸烟发生率更高（32.2% vs. 25.8%；p=0.008）。HBV 组的丙氨酸转氨酶（60.9±85.7 U/L vs. 48.0±52.1 U/L；p=0.003）、血红蛋白（12.7±2.28 g/dL vs. 12.0±2.46 g/dL；p<0.001）、白蛋白（32.9±6.8 g/L vs. 31.3±7.7 g/L；p=0.007）和凝血酶原时间（13.2±2.95 s vs. 12.7±2.01 s；p=0.023）更高。与隐匿性组相比，隐匿性 HCC 患者更常表现为单灶性 HCC（55.2% vs. 46.5%；p=0.002）。两组患者接受手术切除的比例无差异（HBV 组 23.5%，隐匿性组 17.9%；p=0.202）。Cox 回归分析显示，隐匿性相关 HCC 与 HBV 相关 HCC 的生存差异无统计学意义（p=0.367）。
时间趋势表明，HBV 导致的 HCC 正在减少，而隐匿性或 NASH 相关 HCC 是一种新兴的临床实体。鉴于 HCC 流行病学中非病毒性病因的变化，可能需要对 HCC 的筛查、监测和管理方法进行范式转变。
