Nilsson Emma, Anderson Harald, Sargenti Konstantina, Lindgren Stefan, Prytz Hanne
Department of Clinical Sciences, Lund University , Lund , Sweden.
Gastroenterology Clinic, Skåne University Hospital, Lund University , Lund , Sweden.
Scand J Gastroenterol. 2019 Aug;54(8):1027-1032. doi: 10.1080/00365521.2019.1649454. Epub 2019 Aug 7.
Liver cirrhosis is a risk factor for hepatocellular carcinoma (HCC). While the HCC risk is thought to be highest in hepatitis B and hepatitis C, the risk in other cirrhosis etiologies is not fully established. Therefore, we aimed to study the risk and outcome of HCC in alcoholic cirrhosis compared to cirrhosis of other etiologies, in Sweden. We used population-based medical registries to identify patients diagnosed with cirrhosis in the Scania region in southern Sweden between 2001 and 2010. Medical records were reviewed to identify all HCC cases and to register clinical parameters. All patients were followed until death, emigration or December 2017. The cohort comprised 1317 patients with cirrhosis. A total of 200 patient developed HCC, including 75 with prevalent HCC. The annual incidence of HCC after six months was 1.5% in alcoholic cirrhosis and 4.7% in hepatitis C cirrhosis. In alcoholic cirrhosis, 40 patients were diagnosed with HCC during follow-up, of which 15 patients fulfilled the Milan criteria and 10 received treatment, curative or palliative. The overall median survival after HCC diagnosis was 7.7 months, with 4.5, 11 and 9.3 months, in cirrhosis due to alcohol, hepatitis C or remaining causes, respectively. We find an annual incidence of HCC in alcoholic cirrhosis of 1.5% indicating need for surveillance in these patients. Survival after HCC diagnosis was worst in alcoholic cirrhosis due to more advanced stage at diagnosis with few patients eligible for treatment.
肝硬化是肝细胞癌（HCC）的一个危险因素。虽然人们认为乙肝和丙肝导致的肝硬化发生HCC的风险最高，但其他病因导致的肝硬化发生HCC的风险尚未完全明确。因此，我们旨在研究瑞典酒精性肝硬化患者与其他病因导致的肝硬化患者发生HCC的风险及预后情况。我们利用基于人群的医疗登记系统，确定了2001年至2010年间瑞典南部斯科讷地区被诊断为肝硬化的患者。查阅病历以确定所有HCC病例并记录临床参数。对所有患者进行随访，直至其死亡、移民或到2017年12月。该队列包括1317例肝硬化患者。共有200例患者发生HCC，其中75例为现患HCC。酒精性肝硬化患者在6个月后的HCC年发病率为1.5%，丙型肝炎肝硬化患者为4.7%。在酒精性肝硬化患者中，40例在随访期间被诊断为HCC，其中15例符合米兰标准，10例接受了治愈性或姑息性治疗。HCC诊断后的总体中位生存期为7.7个月，酒精性肝硬化、丙型肝炎肝硬化或其他病因导致的肝硬化患者的中位生存期分别为4.5个月、11个月和9.3个月。我们发现酒精性肝硬化患者的HCC年发病率为1.5%，这表明这些患者需要进行监测。由于诊断时分期较晚且符合治疗条件的患者较少，酒精性肝硬化患者在HCC诊断后的生存期最差。
