Rattanasupar Attapon, Chang Arunchai, Prateepchaiboon Tanaporn, Pungpipattrakul Nuttanit, Akarapatima Keerati, Songjamrat Apiradee, Pakdeejit Songklod, Prachayakul Varayu, Piratvisuth Teerha
Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Hatyai 90110, Songkhla, Thailand.
Department of Internal Medicine, Hatyai Hospital, Hatyai 90110, Songkhla, Thailand.
World J Hepatol. 2022 Jun 27;14(6):1162-1172. doi: 10.4254/wjh.v14.i6.1162.
Alcohol consumption increases the risk of hepatocellular carcinoma (HCC) in patients with pre-existing liver disease, including viral hepatitis. However, studies on the impact of alcohol consumption on the outcomes of HCC are limited. We hypothesized that alcohol had an additional effect with chronic viral hepatitis infection on treatment outcomes after transarterial chemoembolization (TACE) in patients with intermediate-stage HCC (Barcelona Clinical Liver Cancer [BCLC] -B).
To evaluate the additional effect of alcohol on treatment outcomes of TACE among HCC patients with viral hepatitis.
This study, conducted at Hatyai Hospital in Thailand, included HCC patients over 18 years of age with chronic viral hepatitis. Records of HCC patients with viral hepatitis classified as BCLC-B who underwent TACE as the first treatment modality between 2014 and 2019 were retrospectively reviewed. Patients with chronic viral hepatitis only were categorized under group A, and those with chronic viral hepatitis and concurrent alcohol consumption were categorized under group B. Both groups were compared, and the Cox proportional-hazards model was used to identify the survival-influencing variables.
Of the 69 patients, 53 were categorized in group A and 16 in group B. There were no statistically significant differences in tumor characteristics between the two patient groups. However, Group A had a statistically significantly higher proportion of complete response (24.5% 0%, = 0.030) and a higher median survival rate (26.2 mo 8.4 mo; log-rank = 0.012) compared to group B. Factors associated with decreased survival in the proportional-hazards model included alcohol consumption (hazards ratio [HR], 2.377; 95% confidence interval [CI], 1.109-5.095; = 0.026), presence of portal hypertension (HR, 2.578; 95%CI, 1.320-5.037; = 0.006), largest tumor size > 5 cm (HR, 3.558; 95%CI, 1.824-6.939; < 0.001), and serum alpha-fetoprotein level > 100 ng/mL (HR, 2.536; 95%CI, 1.377-4.670; = 0.003).
In HCC BCLC B patients with chronic viral hepatitis, alcohol consumption is an independent risk factor for increased mortality and decreases the rate of complete response and survival after TACE.
饮酒会增加包括病毒性肝炎在内的已有肝病患者患肝细胞癌（HCC）的风险。然而，关于饮酒对HCC预后影响的研究有限。我们推测，在中期HCC（巴塞罗那临床肝癌[BCLC]-B期）患者中，饮酒与慢性病毒感染对经动脉化疗栓塞（TACE）后的治疗结果有额外影响。
评估饮酒对病毒性肝炎HCC患者TACE治疗结果的额外影响。
本研究在泰国合艾医院进行，纳入了年龄超过18岁的慢性病毒性肝炎HCC患者。回顾性分析了2014年至2019年间首次接受TACE治疗、分类为BCLC-B期的病毒性肝炎HCC患者的记录。仅患有慢性病毒性肝炎的患者归入A组，患有慢性病毒性肝炎且同时饮酒的患者归入B组。对两组进行比较，并使用Cox比例风险模型确定影响生存的变量。
69例患者中，53例归入A组，16例归入B组。两组患者的肿瘤特征无统计学显著差异。然而，与B组相比，A组的完全缓解率在统计学上显著更高（24.5%对0%，P=0.030），中位生存率更高（26.2个月对8.4个月；对数秩检验P=0.012）。比例风险模型中与生存率降低相关的因素包括饮酒（风险比[HR]，2.377；95%置信区间[CI]，1.109-5.095；P=0.026）、门静脉高压的存在（HR，2.578；95%CI，1.320-5.037；P=0.006）、最大肿瘤直径>5 cm（HR，3.558；95%CI，1.824-6.939；P<0.001）和血清甲胎蛋白水平>100 ng/mL（HR，2.536；95%CI，1.377-4.670；P=0.003）。
在慢性病毒性肝炎的BCLC B期HCC患者中，饮酒是死亡率增加的独立危险因素，并降低TACE后的完全缓解率和生存率。
