Fukunaga Shuhei, Mukasa Michita, Nakane Tomoyuki, Nakano Dan, Tsutsumi Tsubasa, Chou Tomonori, Tanaka Hiroshi, Hayashi Daiki, Minami Shinpei, Ohuchi Akihiro, Nagata Tsutomu, Takaki Kota, Takaki Hiroshi, Miyajima Ichiro, Nouno Ryuichi, Araki Toshihiro, Morita Taku, Torimura Takuji, Okabe Yoshinobu, Kawaguchi Takumi
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
Kumamoto Central Hospital, Kikuchi, Japan.
Hepatol Res. 2024 Feb;54(2):201-212. doi: 10.1111/hepr.13973. Epub 2023 Oct 18.
Metabolic dysfunction is a risk factor for esophageal squamous cell carcinoma (ESCC). We investigated the impact of the recently proposed metabolic dysfunction-associated fatty liver disease (MAFLD) and its subtypes on ESCC recurrence after endoscopic treatment.
This multicenter observational cohort study enrolled consecutive patients newly diagnosed with ESCC after endoscopic treatment. Patients were classified into MAFLD or non-MAFLD groups. The MAFLD group was further classified into non-obese and obese MAFLD groups with a body mass index cutoff value of 25 kg/m . The impact of MAFLD on the recurrence of ESCC was evaluated using a decision tree algorithm and random forest analysis.
A total of 147 patients (average age 69 years; male : female, 127:20; observational period, 2.4 years) were enrolled. The 1-, 3-, and 5-year recurrence rates were 2.0%, 21.1%, and 33.7%, respectively. Independent risk factors for the recurrence of ESCC were MAFLD (HR 2.2812; 95% confidence interval 1.0497-4.9571; p = 0.0373), drinking status, and smoking status. Metabolic dysfunction-associated fatty liver disease was identified as the second most important classifier for recurrence, followed by drinking status. The cumulative incidence of ESCC recurrence was higher in the MAFLD group than in the non-MAFLD group. In a subanalysis, the cumulative incidence of recurrence was significantly higher in the non-obese than in the obese MAFLD group among abstainers/non-drinkers. Directed acyclic graphs revealed that MAFLD directly contributes to ESCC recurrence.
MAFLD was independently and directly associated with ESCC recurrence after endoscopic treatment; a high recurrence rate was observed in patients with non-obese MAFLD. Metabolic dysfunction-associated fatty liver disease may identify patients at high risk for ESCC recurrence.
代谢功能障碍是食管鳞状细胞癌（ESCC）的一个危险因素。我们研究了最近提出的代谢功能障碍相关脂肪性肝病（MAFLD）及其亚型对内镜治疗后ESCC复发的影响。
这项多中心观察性队列研究纳入了在内镜治疗后新诊断为ESCC的连续患者。患者被分为MAFLD组或非MAFLD组。MAFLD组进一步分为非肥胖和肥胖MAFLD组，体重指数临界值为25kg/m²。使用决策树算法和随机森林分析评估MAFLD对ESCC复发的影响。
共纳入147例患者（平均年龄69岁；男∶女，127∶20；观察期2.4年）。1年、3年和5年复发率分别为2.0%、21.1%和33.7%。ESCC复发的独立危险因素为MAFLD（HR 2.2812；95%置信区间1.0497 - 4.9571；p = 0.0373）、饮酒状况和吸烟状况。代谢功能障碍相关脂肪性肝病被确定为复发的第二重要分类因素，其次是饮酒状况。MAFLD组ESCC复发的累积发生率高于非MAFLD组。在一项亚分析中，在戒酒者/非饮酒者中，非肥胖MAFLD组的复发累积发生率显著高于肥胖MAFLD组。有向无环图显示MAFLD直接导致ESCC复发。
MAFLD与内镜治疗后ESCC复发独立且直接相关；非肥胖MAFLD患者的复发率较高。代谢功能障碍相关脂肪性肝病可能识别出ESCC复发高危患者。
