Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA.
Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, USA.
Aliment Pharmacol Ther. 2024 Jul;60(2):212-223. doi: 10.1111/apt.18024. Epub 2024 May 1.
Adverse outcomes of cirrhosis remain a top priority.
We examined the distribution of cirrhosis causes, HCC incidence and mortality and related changes over time in a nationwide U.S.
A retrospective study of a national sample of commercially insured patients with cirrhosis from Optum's de-identified Clinformatics® Data Mart Database (CDM).
A total of 628,743 cirrhosis cases were identified with 45% having NAFLD, 19.5% HCV, and 16.3% ALD. African Americans had the highest rate of decompensation (60.6%), while Asians had the highest rate of HCC (2.4%), both p < 0.001. African Americans more frequently had HCV (28.4%) while Hispanic/Latinos more frequently had NAFLD (49.2%, p < 0.001). Patients in the 2014-2021 cohort were significantly older (63.0 ± 12.8 vs. 57.0 ± 14.3), less frequently decompensated (54.5% vs. 58.3%) but more frequently had HCC (1.7% vs. 0.6%) and NAFLD (46.5% vs. 44.2%), all p < 0.001. The overall annual incidence of HCC was 0.76% (95% CI: 0.75-0.77) with a 5-year cumulative incidence of 4.03% (95% CI: 3.98-4.09), with significant variation by sex, race/ethnicity, and cirrhosis aetiology. The overall median years of survival were 11.4 (95% CI: 11.3-11.5) with a 5-year cumulative survival of 73.4% (95% CI: 73.3%-73.6%), also with significant disparities in similar subgroups (lowest in cryptogenic cirrhosis and worse in 2014-2021 vs. 2003-2013). The 2014-2021 period was independently associated with worse survival (aHR: 1.14, 95% CI: 1.08-1.20).
HCC incidence and survival vary by aetiology among patients with cirrhosis, with cryptogenic cirrhosis having the lowest survival and lower survival in the more recent time period.
肝硬化的不良后果仍然是重中之重。
我们在美国全国范围内研究了肝硬化病因、HCC 发病率和死亡率的分布情况以及随时间的相关变化。
这是一项针对来自 Optum 去识别 Clinformatics® Data Mart 数据库（CDM）的商业保险肝硬化患者的全国性样本的回顾性研究。
共确定了 628743 例肝硬化病例，其中 45%为非酒精性脂肪性肝病，19.5%为丙型肝炎病毒，16.3%为酒精性肝病。非裔美国人的失代偿发生率最高（60.6%），而亚洲人的 HCC 发生率最高（2.4%），均 < 0.001。非裔美国人更常患有丙型肝炎（28.4%），而西班牙裔/拉丁裔更常患有非酒精性脂肪性肝病（49.2%，p < 0.001）。2014-2021 年队列的患者年龄明显较大（63.0±12.8 岁比 57.0±14.3 岁），失代偿发生率较低（54.5%比 58.3%），但 HCC 发生率（1.7%比 0.6%）和非酒精性脂肪性肝病（46.5%比 44.2%）较高，均 < 0.001。HCC 的总体年发病率为 0.76%（95%CI：0.75-0.77），5 年累积发病率为 4.03%（95%CI：3.98-4.09），性别、种族/民族和肝硬化病因存在显著差异。中位总生存年限为 11.4 年（95%CI：11.3-11.5），5 年累积生存率为 73.4%（95%CI：73.3%-73.6%），在类似亚组中也存在显著差异（最低为不明原因肝硬化，2014-2021 年比 2003-2013 年更差）。2014-2021 年期间与生存状况较差独立相关（aHR：1.14，95%CI：1.08-1.20）。
肝硬化患者的 HCC 发病率和生存率因病因而异，不明原因肝硬化的生存率最低，近期生存率更低。
