美国非酒精性脂肪性肝病相关肝细胞癌的临床特征和结局。
Clinical Characteristics and Outcomes of Nonalcoholic Fatty Liver Disease-Associated Hepatocellular Carcinoma in the United States.
机构信息
Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas; Population Informatics Lab, School of Public Health, Texas A&M University, College Station, Texas.
Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
出版信息
Clin Gastroenterol Hepatol. 2023 Mar;21(3):670-680.e18. doi: 10.1016/j.cgh.2022.03.010. Epub 2022 Mar 17.
BACKGROUND & AIMS: The extent to which nonalcoholic fatty liver disease (NAFLD) contributes to hepatocellular carcinoma (HCC) prevalence in contemporary practices and whether there are any etiologic differences in surveillance receipt, tumor stage, and overall survival (OS) remain unclear. We aimed to estimate the burden of NAFLD-related HCC and magnitude of associations with surveillance receipt, clinical presentation, and outcomes in a contemporary HCC cohort.
METHODS
In a cohort of HCC patients from the Surveillance, Epidemiology and End Results-Medicare database between 2011 and 2015, we used multivariable logistic regression to identify factors associated with surveillance receipt, early-stage tumor detection, and curative treatment. Cox regression was used to identify factors associated with OS.
RESULTS
Among 5098 HCC patients, NAFLD was the leading etiology, accounting for 1813 cases (35.6%). Compared with those with hepatitis C-related HCC, NAFLD was associated with lower HCC surveillance receipt (adjusted odds ratio, 0.22; 95% confidence interval [CI], 0.17-0.28), lower early-stage HCC detection (adjusted odds ratio, 0.49; 95% CI, 0.40-0.60), and modestly worse OS (adjusted hazard ratio, 1.20; 95% CI, 1.09-1.32). NAFLD subgroup analysis showed that early-stage HCC, absence of ascites/hepatic encephalopathy, surveillance, and curative treatment receipt were associated with improved OS. NAFLD patients with coexisting liver disease were more likely to have surveillance, early-stage detection, curative treatment, and improved OS than NAFLD patients without coexisting liver diseases.
CONCLUSIONS
NAFLD is the leading etiology of HCC among Medicare beneficiaries. Compared with other etiologies, NAFLD was associated with lower HCC surveillance receipt, early-stage detection, and modestly poorer survival. Multifaceted interventions for improving surveillance uptake are needed to improve prognosis of patients with NAFLD-related HCC.
背景与目的
非酒精性脂肪性肝病（NAFLD）在当代实践中对肝细胞癌（HCC）患病率的影响程度，以及在监测接受情况、肿瘤分期和总生存（OS）方面是否存在任何病因学差异尚不清楚。我们旨在评估 NAFLD 相关 HCC 的负担，并估计其与当代 HCC 患者队列中监测接受情况、临床表现和结局的关联程度。
方法
在 2011 年至 2015 年间，我们使用 Surveillance，Epidemiology and End Results-Medicare 数据库中的 HCC 患者队列，使用多变量逻辑回归来确定与监测接受情况、早期肿瘤检测和根治性治疗相关的因素。Cox 回归用于确定与 OS 相关的因素。
结果
在 5098 例 HCC 患者中，NAFLD 是主要病因，占 1813 例（35.6%）。与丙型肝炎相关 HCC 相比，NAFLD 与 HCC 监测接受率较低相关（调整后的优势比，0.22；95%置信区间[CI]，0.17-0.28），早期 HCC 检测率较低（调整后的优势比，0.49；95%CI，0.40-0.60），OS 略差（调整后的风险比，1.20；95%CI，1.09-1.32）。NAFLD 亚组分析显示，早期 HCC、无腹水/肝性脑病、监测和根治性治疗的接受与 OS 改善相关。患有共存肝病的 NAFLD 患者比没有共存肝病的 NAFLD 患者更有可能接受监测、早期检测、根治性治疗和改善 OS。
结论
NAFLD 是医疗保险受益人群中 HCC 的主要病因。与其他病因相比，NAFLD 与 HCC 监测接受率较低、早期检测和适度较差的生存相关。需要采取多方面的干预措施来提高 NAFLD 相关 HCC 患者的监测接受率，以改善其预后。
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