Yan Bing, Bai Dou-Sheng, Qian Jian-Jun, Zhang Chi, Jin Sheng-Jie, Wang Xuehao, Jiang Guo-Qing
Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou 225001, China.
Department of Hepatobiliary Surgery, The Second Clinical College, Dalian Medical University, Dalian 116044, China.
J Cancer. 2020 Aug 3;11(19):5812-5821. doi: 10.7150/jca.46927. eCollection 2020.
Liver cirrhosis is a major risk factor for hepatocellular carcinoma (HCC). However, 10%-20% of patients with HCC do not have cirrhosis. The aim of this study was to explore the potential differences in tumour characteristics of HCC between patients with and without cirrhosis. In this study, we identified total 10,849 patients with HCC diagnosed between 2010 and 2016, from the SEER database. The degree of fibrosis was categorized as "no cirrhosis" (Ishak score 0-4) or "cirrhosis" (Ishak score 5-6). Among all patients with HCC, patients with no cirrhosis and with cirrhosis accounted for 1800 (16.6%) and 9049 (83.4%), respectively. Significant negative correlations were observed between no cirrhosis/cirrhosis and pathological grade (r =-0.074, P <0.001), tumour size (r =-0.186, P <0.001), N stage (r =-0.024, P =0.025), M stage (r =-0.036, P <0.001), liver metastasis (r =-0.024, P =0.014), and lung metastasis (r =-0.027, P =0.006). Logistic multivariate regression analysis showed that, compared with cirrhosis, no cirrhosis is an independent risk predictor of pathological grade [odds ratio (OR), 0.685; 95% confidence interval (CI), 0.571-0.822; P < 0.001], tumour size (OR, 0.392; 95% CI, 0.351-0.437; P < 0.001), N stage (OR, 0.704; 95% CI, 0.561-0.883; P < 0.001), and M stage (OR, 0.671; 95% CI, 0.561-0.804; P < 0.001). Compared with cirrhosis, no cirrhosis is significantly associated with worse pathological grade, larger tumour size, and more lymph node and distant metastases. Patients without cirrhosis that are otherwise neglected in HCC clinical practice require intensive focus in future studies.
肝硬化是肝细胞癌（HCC）的主要危险因素。然而，10%-20%的HCC患者并无肝硬化。本研究旨在探讨有肝硬化和无肝硬化的HCC患者在肿瘤特征方面的潜在差异。在本研究中，我们从监测、流行病学和最终结果（SEER）数据库中确定了2010年至2016年间确诊的总计10849例HCC患者。纤维化程度分为“无肝硬化”（伊沙克评分0-4）或“肝硬化”（伊沙克评分5-6）。在所有HCC患者中，无肝硬化和有肝硬化的患者分别占1800例（16.6%）和9049例（83.4%）。无肝硬化/肝硬化与病理分级（r = -0.074，P <0.001）、肿瘤大小（r = -0.186，P <0.001）、N分期（r = -0.024，P =0.025）、M分期（r = -0.036，P <0.001）、肝转移（r = -0.024，P =0.014）及肺转移（r = -0.027，P =0.006）之间存在显著负相关。Logistic多因素回归分析显示，与肝硬化相比，无肝硬化是病理分级[比值比（OR），0.685；95%置信区间（CI），0.571-0.822；P <0.001]、肿瘤大小（OR，0.392；95%CI，0.351-0.437；P <0.001）、N分期（OR，0.704；95%CI，0.561-0.883；P <0.001）及M分期（OR，0.671；95%CI，0.561-0.804；P <0.001）的独立风险预测因素。与肝硬化相比，无肝硬化与更差的病理分级、更大的肿瘤大小以及更多的淋巴结和远处转移显著相关。在HCC临床实践中未得到充分关注的无肝硬化患者在未来研究中需要重点关注。
