非酒精性脂肪性肝病和代谢危险因素对肝细胞癌患者等待名单结局的影响。
Effect of Nonalcoholic Fatty Liver Disease and Metabolic Risk Factors on Waitlist Outcomes in Patients With Hepatocellular Carcinoma.
作者信息
Weinfurtner Kelley, Dodge Jennifer L, Yao Francis Y K, Mehta Neil
机构信息
Department of Medicine, University of California, San Francisco, San Francisco, CA.
Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA.
出版信息
Transplant Direct. 2020 Sep 17;6(10):e605. doi: 10.1097/TXD.0000000000001060. eCollection 2020 Oct.
UNLABELLED
Nonalcoholic fatty liver disease (NAFLD) is a leading cause of hepatocellular carcinoma (HCC) in the United States. Prior data suggest that NAFLD-HCC patients are less likely to receive liver transplantation (LT) and have worse overall survival; however, the reason for this discrepancy is unknown.
METHODS
We conducted a retrospective study of 631 HCC patients listed for LT at a large academic center from 2004 to 2013. Waitlist dropout and LT were analyzed using competing risk regression.
RESULTS
Compared with other-HCC patients (n = 589), NAFLD-HCC patients (n = 42, 6.7%) were older (65 versus 58, < 0.001) with more women (50.0 versus 23.6%, < 0.001), Hispanic ethnicity (40.5 versus 17.7%, = 0.001), obesity (69.0 versus 29.9%, < 0.001), diabetes mellitus (59.5 versus 27.8%, < 0.01), insulin-dependence (23.8 versus 10.2%, = 0.007), hyperlipidemia (40.5 versus 10.5, < 0.001), and statin use (33.3 versus 5.3%, < 0.001). Cumulative incidence of waitlist dropout at 2 y was 17.4% (95% confidence intervals, 7.7-30.4) for NAFLD HCC and 25.4% (95% confidence intervals, 21.9-29.0) for other HCC ( = 0.28). No difference in waitlist dropout or receipt of LT between NAFLD HCC and other HCC was found on regression analysis. Similarly, NAFLD and obesity, obesity alone, diabetes mellitus, insulin-dependence, hyperlipidemia, and statin use were not associated with waitlist outcomes. Finally, we observed no statistically significant difference in 5-y survival from HCC diagnosis between NAFLD HCC and other HCC (78.5% versus 66.9%, = 0.9).
CONCLUSIONS
In our single-center cohort, we observed no difference in waitlist outcomes or survival in NAFLD HCC, although conclusions are limited by the small number of NAFLD-HCC patients. Notably, the inclusion of patients with obesity in the NAFLD-HCC group and stratification by individual metabolic factors also showed no difference in waitlist outcomes.
未标注
非酒精性脂肪性肝病（NAFLD）是美国肝细胞癌（HCC）的主要病因。既往数据表明，NAFLD-HCC患者接受肝移植（LT）的可能性较小，总体生存率较差；然而，这种差异的原因尚不清楚。
方法
我们对2004年至2013年在一家大型学术中心登记等待LT的631例HCC患者进行了回顾性研究。使用竞争风险回归分析等待名单退出和LT情况。
结果
与其他HCC患者（n = 589）相比，NAFLD-HCC患者（n = 42，6.7%）年龄更大（65岁对58岁，<0.001），女性更多（50.0%对23.6%，<0.001），西班牙裔（40.5%对17.7%，=0.001），肥胖（69.0%对29.9%，<0.001），糖尿病（59.5%对27.8%，<0.01），胰岛素依赖（23.8%对10.2%，=0.007），高脂血症（40.5%对10.5%，<0.001），以及使用他汀类药物（33.3%对5.3%，<0.001）。NAFLD HCC患者2年时等待名单退出的累积发生率为17.4%（95%置信区间，7.7 - 30.4），其他HCC患者为25.4%（95%置信区间，21.9 - 29.0）（P = 0.28）。回归分析未发现NAFLD HCC和其他HCC在等待名单退出或接受LT方面存在差异。同样，NAFLD和肥胖、单纯肥胖、糖尿病、胰岛素依赖、高脂血症以及使用他汀类药物与等待名单结局无关。最后，我们观察到NAFLD HCC和其他HCC从HCC诊断开始的5年生存率无统计学显著差异（78.5%对66.9%，P = 0.9）。
结论
在我们的单中心队列中，尽管结论因NAFLD-HCC患者数量较少而受到限制，但我们观察到NAFLD HCC在等待名单结局或生存率方面没有差异。值得注意的是，NAFLD-HCC组中纳入肥胖患者并按个体代谢因素分层，在等待名单结局方面也没有差异。
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