Department of General-, Visceral- and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.
J Gastrointest Surg. 2021 May;25(5):1193-1202. doi: 10.1007/s11605-020-04628-0. Epub 2020 May 6.
Non-alcoholic steatohepatitis (NASH) associated hepatocellular carcinomas (NASH-HCC) are increasing. NASH-HCC often develops in the fibrotic liver. Several analyses report conflicting results regarding the outcome of non-cirrhotic NASH-HCC. Furthermore, type 2 diabetes (T2D) is considered a risk factor for poor survival. The aim of this study was to investigate oncological outcomes of non-cirrhotic NASH-HCC and the impact of T2D.
Patients with non-cirrhotic NASH-HCC with T2D as determined by an expert pathologist conducting histological slide review were matched for risks factors for poor outcome (age, gender, body mass index) with patients with NASH-HCC without T2D. These patients were then matched 1:1 with HCCs of other underlying liver diseases with and without T2D. Oncological outcomes were assessed using Kaplan-Meier curves.
Out of 365 HCCs resected between 2001 and 2017, 34 patients with non-cirrhotic NASH-HCC were selected (17 with T2D, 17 without T2D) and matched with 26 patients with hepatitis-HCC and 28 patients with alcohol-related HCC. Oncological risk factors such as tumor size, resection margin, and vessel invasion were comparable. There was no difference in overall survival (5-year survival 71.3% for NASH-HCC, 60.4% for hepatitis-HCC, 79.9% for alcohol-HCC). NASH-HCC was associated with longer disease-specific survival than hepatitis-HCC (5-year 87.5% vs. 63.7%, p = 0.048), while recurrence-free survival was identical. T2D had no impact on oncological outcomes in either liver disease.
Non-cirrhotic NASH-HCC has outcomes comparable with other underling etiologies. Despite a lack of cirrhosis, patients with non-cirrhotic NASH-HCC have the same risks of HCC recurrence as patients with cirrhotic liver disease of other etiologies.
非酒精性脂肪性肝炎（NASH）相关肝细胞癌（NASH-HCC）正在增加。NASH-HCC 常发生在纤维化的肝脏中。几项分析报告了非肝硬化性 NASH-HCC 结果的相互矛盾的结果。此外，2 型糖尿病（T2D）被认为是预后不良的危险因素。本研究旨在探讨非肝硬化性 NASH-HCC 的肿瘤学结果以及 T2D 的影响。
通过专家病理学家进行组织学切片复查确定患有 T2D 的非肝硬化性 NASH-HCC 患者，与患有 NASH-HCC 且无 T2D 的患者按不良预后的危险因素（年龄、性别、体重指数）进行匹配。然后，将这些患者与患有其他基础肝病的 HCC 患者（无论是否患有 T2D）按 1:1 进行匹配。使用 Kaplan-Meier 曲线评估肿瘤学结果。
在 2001 年至 2017 年间切除的 365 个 HCC 中，选择了 34 名患有非肝硬化性 NASH-HCC 的患者（17 名患有 T2D，17 名无 T2D），并与 26 名乙型肝炎-HCC 患者和 28 名酒精性 HCC 患者进行了匹配。肿瘤大小、切缘和血管侵犯等肿瘤学危险因素相似。总体生存率无差异（NASH-HCC 的 5 年生存率为 71.3%，乙型肝炎-HCC 的 60.4%，酒精性-HCC 的 79.9%）。NASH-HCC 的疾病特异性生存率高于乙型肝炎-HCC（5 年生存率为 87.5% vs. 63.7%，p=0.048），而无复发生存率相同。T2D 对任何一种肝病的肿瘤学结果均无影响。
非肝硬化性 NASH-HCC 的结果与其他基础病因相似。尽管没有肝硬化，但非肝硬化性 NASH-HCC 患者与其他病因引起的肝硬化性肝病患者的 HCC 复发风险相同。
