Rodríguez Manuel, González-Diéguez María Luisa, Varela María, Cadahía Valle, Andrés-Vizán Sara María, Mesa Alicia, Castaño Andrés, Alvarez-Navascués Carmen
Liver Unit, Division of Gastroenterology & Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), University of Oviedo, Oviedo, Spain.
Am J Gastroenterol. 2021 Dec 1;116(12):2390-2398. doi: 10.14309/ajg.0000000000001399.
Although alcohol cessation is the only effective treatment for alcohol-related liver disease, few data exist concerning its influence on the risk of hepatocellular carcinoma (HCC). We aimed to evaluate the effect of alcohol abstinence on the incidence of HCC in patients with alcohol-related cirrhosis.
We studied 727 patients with alcohol-related cirrhosis (247 with compensated disease and 480 with previous decompensation) who were included in a surveillance program for the early detection of HCC and prospectively followed. Baseline clinical and biological parameters and alcohol consumption during follow-up were recorded. Abstinence was defined as the absence of any alcohol use.
During follow-up (median 54 months), 354 patients (48.7%) remained abstinent and 104 developed HCC (2.3 per 100 person-years). Factors independently associated with the risk of HCC among patients with previous decompensation were age, male gender, and aspartate aminotransferase, whereas abstinence was not linked to a reduced risk (hazard ratio 0.95; 95% confidence interval 0.59-1.52). However, among patients without previous decompensation, prothrombin activity and abstinence were independently associated with the risk of HCC. Abstinent patients had a significant decrease in the risk of developing tumor (hazard ratio 0.35; 95% confidence interval 0.13-0.94). These results did not change after applying a competing risk analysis where death and liver transplantation were considered as competing events.
Alcohol abstinence reduced the risk of HCC in patients with alcohol-related cirrhosis, but only in those without a history of decompensated disease. This finding emphasizes the need for an early diagnosis of alcohol-related liver disease and for implementing strategies leading to an increase in the rate of achieving and maintaining abstinence among this population.
尽管戒酒是治疗酒精性肝病的唯一有效方法，但关于其对肝细胞癌（HCC）风险影响的数据却很少。我们旨在评估戒酒对酒精性肝硬化患者发生HCC的影响。
我们研究了727例酒精性肝硬化患者（247例为代偿期疾病患者，480例有既往失代偿史），这些患者被纳入HCC早期检测监测项目并进行前瞻性随访。记录基线临床和生物学参数以及随访期间的酒精摄入量。戒酒定义为无任何酒精使用。
在随访期间（中位时间54个月），354例患者（48.7%）保持戒酒，104例发生HCC（每100人年2.3例）。既往有失代偿史的患者中，与HCC风险独立相关的因素为年龄、男性性别和天冬氨酸转氨酶，而戒酒与风险降低无关（风险比0.95；95%置信区间0.59 - 1.52）。然而，在无既往失代偿史的患者中，凝血酶原活性和戒酒与HCC风险独立相关。戒酒患者发生肿瘤的风险显著降低（风险比0.35；95%置信区间0.13 - 0.94）。在将死亡和肝移植视为竞争事件进行竞争风险分析后，这些结果并未改变。
戒酒降低了酒精性肝硬化患者发生HCC的风险，但仅在无失代偿疾病史的患者中如此。这一发现强调了对酒精性肝病进行早期诊断以及实施提高该人群戒酒达成率和维持率策略的必要性。
