Indiana University School of Medicine, Indianapolis, Indiana.
MD Anderson Cancer Center, Houston, Texas.
Aliment Pharmacol Ther. 2019 Oct;50(7):809-821. doi: 10.1111/apt.15464. Epub 2019 Sep 1.
Limited data exist on the burden and features of non-cirrhotic hepatocellular carcinoma (HCC) in the United States.
To evaluate characteristics, aetiologies, trends and outcomes of non-cirrhotic HCC from 2000 to 2014 at five large US centres METHODS: Patient, tumour and liver disease aetiology data were collected. The presence of underlying cirrhosis was assessed based on published criteria.
Of 5144 eligible patients with HCC, 11.7% had no underlying cirrhosis. Non-cirrhotic patients were older (64.1 vs 61.2 years), more frequently females (33.9% vs 20.8%) and less frequently black (8.3% vs 12.4%) (P < .001 for all). Among non-cirrhotic patients, non-alcoholic fatty liver disease (NAFLD) was the most common liver disease (26.3%), followed by hepatitis C virus (HCV) (12.1%) and hepatitis B virus (HBV) (10%) infections. As of 2014, there was increased percentage of cirrhotic HCC and a decline in non-cirrhotic HCC mainly due to significant annual increases in cirrhotic HCC due to HCV (0.96% [P < .0001]) and NAFLD (0.66% [P = .003]). Patients with non-cirrhotic HCC had larger tumours (8.9 vs 5.3 cm), were less frequently within Milan criteria (15% vs 39%), more frequently underwent resection (43.6% vs 8%) (P < .001 for all) and had better overall survival than cirrhotic HCC patients (median 1.8 vs 1.3 years, P = .004).
Nearly 12% of HCCs occurred in patients without underlying cirrhosis. NAFLD was the most common liver disease in these patients. During the study, the frequency of non-cirrhotic HCC decreased, whereas that of cirrhotic HCC increased. Although non-cirrhotic patients presented with more advanced HCC, their survival was better.
在美国，有关非肝硬化性肝细胞癌（HCC）的负担和特征的数据有限。
评估 2000 年至 2014 年在美国五个大型中心的非肝硬化性 HCC 的特征、病因、趋势和结局。
收集患者、肿瘤和肝脏疾病病因数据。根据已发表的标准评估是否存在潜在的肝硬化。
在 5144 名符合条件的 HCC 患者中，有 11.7%的患者没有潜在的肝硬化。非肝硬化患者年龄较大（64.1 岁 vs 61.2 岁），女性比例较高（33.9% vs 20.8%），黑人比例较低（8.3% vs 12.4%）（所有 P 值均<.001）。在非肝硬化患者中，非酒精性脂肪性肝病（NAFLD）是最常见的肝脏疾病（26.3%），其次是丙型肝炎病毒（HCV）（12.1%）和乙型肝炎病毒（HBV）（10%）感染。截至 2014 年，肝硬化 HCC 的比例有所增加，非肝硬化 HCC 的比例有所下降，主要是由于 HCV（0.96%[P<.0001]）和 NAFLD（0.66%[P=.003]）引起的肝硬化 HCC 年增长率显著增加。非肝硬化 HCC 患者的肿瘤较大（8.9 厘米 vs 5.3 厘米），更常不符合米兰标准（15% vs 39%），更常接受切除术（43.6% vs 8%）（所有 P 值均<.001），并且总体生存率优于肝硬化 HCC 患者（中位 1.8 年 vs 1.3 年，P=.004）。
近 12%的 HCC 发生在无潜在肝硬化的患者中。在这些患者中，NAFLD 是最常见的肝脏疾病。在研究期间，非肝硬化性 HCC 的频率下降，而肝硬化性 HCC 的频率增加。尽管非肝硬化患者的 HCC 更为晚期，但他们的生存率更高。
