代谢功能障碍相关脂肪性肝病已成为瑞典最常见的肝细胞癌病因：一项全国性队列研究。

Metabolic dysfunction-associated steatotic liver disease has become the most common cause of hepatocellular carcinoma in Sweden: A nationwide cohort study.

机构信息

Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden.

Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.

出版信息

Int J Cancer. 2025 Jan 1;156(1):40-51. doi: 10.1002/ijc.35097. Epub 2024 Jul 17.

DOI:10.1002/ijc.35097

PMID:39016032

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease globally, and can lead to hepatocellular carcinoma (HCC), a leading cause of cancer-related death. We aimed to determine the extent to which MASLD is an increasing cause of HCC in Sweden and to determine clinical characteristics associated with underlying MASLD. Using the Swedish quality registry for liver cancer (SweLiv), we identified all adults with a diagnosis of HCC in Sweden between 2012 and 2018. Baseline data were retrieved from SweLiv and other nationwide registers. Totally, 3494 patients with HCC were identified. Of them, 757 patients (22%) had MASLD-HCC. The proportion with MASLD-HCC increased from 19% in 2012 to 25% in 2018 (p = 0.012), and MASLD was since 2017 the leading cause of HCC, surpassing hepatitis C. MASLD was the fastest growing cause of HCC with a 33% increment during the study period. Compared to other patients with HCC, those with MASLD-HCC were older (75 vs. 67 years, p < .001), less commonly had cirrhosis (61% vs. 82%, p < .001), had larger tumours (median 5.5 vs. 4.3 cm, p < .001), and more often extrahepatic metastasis (22% vs. 16%, p < .001). Patients with HCC caused by MASLD or by other causes were equally likely to be diagnosed in an early stage (Barcelona Clinic Liver Cancer 0-A, 27% vs. 30%, p = .129). MASLD is now the leading cause of HCC in Sweden.

摘要

代谢相关脂肪性肝病相关的脂肪性肝疾病（MASLD）是全球最普遍的慢性肝病，可导致肝细胞癌（HCC），这是癌症相关死亡的主要原因。我们旨在确定 MASLD 在多大程度上成为瑞典 HCC 的一个日益重要的病因，并确定与潜在 MASLD 相关的临床特征。我们使用瑞典肝癌质量登记处（SweLiv），确定了 2012 年至 2018 年间瑞典所有被诊断为 HCC 的成年人。从 SweLiv 和其他全国性登记处获取基线数据。共确定了 3494 例 HCC 患者。其中，757 例（22%）患有 MASLD-HCC。患有 MASLD-HCC 的比例从 2012 年的 19%增加到 2018 年的 25%（p=0.012），并且自 2017 年以来，MASLD 成为 HCC 的主要病因，超过了丙型肝炎。MASLD 是 HCC 增长最快的病因，在研究期间增加了 33%。与其他 HCC 患者相比，患有 MASLD-HCC 的患者年龄更大（75 岁比 67 岁，p<0.001），肝硬化发生率更低（61%比 82%，p<0.001），肿瘤更大（中位数 5.5 厘米比 4.3 厘米，p<0.001），更常发生肝外转移（22%比 16%，p<0.001）。由 MASLD 或其他原因引起的 HCC 患者同样可能在早期被诊断（巴塞罗那临床肝癌 0-A 期，27%比 30%，p=0.129）。MASLD 现在是瑞典 HCC 的主要病因。