Pons Mònica, Rivera-Esteban Jesús, Manzano Ramiro, Bañares Juan, Bermúdez María, Vargas Víctor, Salcedo-Allende Maria Teresa, Castells Lluís, Augustin Salvador, Mínguez Beatriz, Pericàs Juan M
Liver Unit, Vall d'Hebron University Hospital, 08035 Barcelona, Spain.
Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Campus Hospitalari, 08035 Barcelona, Spain.
J Clin Med. 2022 Apr 27;11(9):2466. doi: 10.3390/jcm11092466.
Background: The potential role of non-invasive tests (NITs) for liver fibrosis for hepatocellular carcinoma (HCC) prediction remains poorly known. Methods: Retrospective analysis of a NAFLD cohort from a single university hospital in Barcelona, Spain. Incidence rates and cumulative incidence for the overall cohort, as well as cirrhotic and non-cirrhotic patients were calculated. Logistic regression analyses were carried out to investigate risk factors of HCC. Results: From the entire cohort of 1040 patients, 996 patients (95.8%) were analyzed, in whom 35 cases of HCC were detected, of which 26 (72.4%) HCC incident cases were newly diagnosed during a median follow-up of 2.5 (1.9−3.6) years. Two-hundred and thirty-one (23.2%) were cirrhotic at baseline. With the exception of 2 (7.7%) cases of HCC, the rest were diagnosed in cirrhotic patients. Overall HCC cumulative incidence was 9.49 (95% CI 6.4−13.9) per 1000 person-years. The incidence rate for cirrhotic patients was 41.2 (95% CI 27.6−61.6) per 1000 person-years and 0.93 (95% CI 0.23−3.7) per 1000 person-years for patients without cirrhosis. Overall mortality was significantly higher amongst patients with HCC (4.4% vs. 30.8%, p < 0.001). In patients with available liver biopsy (n = 249, 25%), advanced fibrosis (F3−F4) was significantly associated with higher HCC incidence, but not steatosis, lobular inflammation, nor ballooning. In the overall cohort, FIB-4 ≥1.3 (HR 8.46, 95% CI 1.06−67.4, p = 0.044) and older age (HR 1.06, 95% CI 1.01−1.11, p = 0.025) were associated with increasing risk of HCC over time, whereas in cirrhotic patients predictors of HCC included decreasing values of albumin (HR 0.34, 95% CI 0.13−0.87, p = 0.024), platelets (HR 0.98, 95% CI 0.98−0.99, p = 0.001), and increasing values of liver stiffness (HR 1.03, 95% CI 1.00−1.06, p = 0.016). Conclusions: In a Spanish cohort of NAFLD patients, HCC was rare in non-cirrhotic patients. NITs might play a relevant role at predicting HCC.
非侵入性检测（NITs）在预测肝细胞癌（HCC）肝纤维化方面的潜在作用仍鲜为人知。方法：对西班牙巴塞罗那一家大学医院的非酒精性脂肪性肝病（NAFLD）队列进行回顾性分析。计算了整个队列以及肝硬化和非肝硬化患者的发病率和累积发病率。进行逻辑回归分析以研究HCC的危险因素。结果：在1040例患者的整个队列中，分析了996例患者（95.8%），其中检测到35例HCC，其中26例（72.4%）HCC发病病例在中位随访2.5（1.9 - 3.6）年期间新诊断。231例（23.2%）在基线时为肝硬化。除2例（7.7%）HCC病例外，其余均在肝硬化患者中诊断。总体HCC累积发病率为每1000人年9.49（95%CI 6.4 - 13.9）。肝硬化患者的发病率为每1000人年41.2（95%CI 27.6 - 61.6），非肝硬化患者为每1000人年0.93（95%CI 0.23 - 3.7）。HCC患者的总体死亡率显著更高（4.4%对30.8%，p < 0.001）。在有肝活检的患者（n = 249，25%）中，高级纤维化（F3 - F4）与较高的HCC发病率显著相关，但与脂肪变性、小叶炎症或气球样变无关。在整个队列中，FIB - 4≥1.3（HR 8.46，95%CI 1.06 - 67.4，p = 0.044）和年龄较大（HR 1.06，95%CI 1.01 - 1.11，p = 0.025）与HCC风险随时间增加相关，而在肝硬化患者中，HCC的预测因素包括白蛋白值降低（HR 0.34，95%CI 0.13 - 0.87，p = 0.024）、血小板（HR 0.98，95%CI 0.98 - 0.99，p = 0.001）以及肝硬度值增加（HR 1.03，95%CI 1.00 - 1.06，p = 0.016）。结论：在西班牙的NAFLD患者队列中，非肝硬化患者中HCC罕见。NITs在预测HCC方面可能发挥相关作用。
