Herrera Iván, Almenara Susana, Bellot Pablo, Miralles Cayetano, Rodriguez Maria, Gómez-González Lucia, Palazón José M, Pascual Sonia, Zapater Pedro
Liver Unit, Dr. Balmis General University Hospital, Alicante, Spain.
Institute of Research, Development and Innovation in Healthcare Biotechnology of Elche (IDiBE), University Miguel Hernández de Elche, Spain.
J Clin Exp Hepatol. 2024 Nov-Dec;14(6):101472. doi: 10.1016/j.jceh.2024.101472. Epub 2024 Jun 22.
BACKGROUND & AIMS: This study aims to assess the incidence and characteristics of all cancers, hepatocellular carcinoma (HCC), and extrahepatic cancers in patients with cirrhosis of various etiologies.
Prospective cohort study in patients with cirrhosis but no cancer, followed every 6-9 months through the HCC early detection program. Cancer incidence was compared with Spanish population data to calculate standardized incidence ratios (SIR), and cumulative incidence was calculated separately for cancer and competing events. Longitudinal outcomes were assessed with multivariate Fine-Gray and Cox regression models.
A total of 215 patients (68.4% male, median age 61 years) were included. Cirrhotic etiology was alcohol (38%), hepatitis B or C virus infection (36%), alcohol plus hepatitis B or C virus infection (9%), and other causes (17%). Sixty percent were current or former smokers. Thirty-nine cancers were observed (56% liver cancer), while 3.3 were expected (SIR 11.7; 95% confidence interval [CI] 8.6-16.1). Ten (4.6%) patients were censored for liver transplantation and 34 (15.8%) for death, constituting relevant competing risks. Smoking was significantly associated with overall cancer incidence (smokers: subdistribution hazard ratio [SHR] 3.14, 95% CI 1.33-7.38; former smokers: SHR 2.54, 95% CI 1.08-5.98). In the multivariable regression analysis, viral etiology, Child-Pugh score (B or C versus A), and smoking were associated with liver cancer, and smoking with extrahepatic cancer.
Patients with cirrhosis have an 11-fold risk of cancer compared to the general population. Risk is increased in liver and non-liver cancers. Active surveillance of any type of cancer and smoking cessation interventions are needed in these patients.
本研究旨在评估不同病因肝硬化患者中所有癌症、肝细胞癌（HCC）及肝外癌症的发病率和特征。
对无癌症的肝硬化患者进行前瞻性队列研究，通过HCC早期检测项目每6 - 9个月随访一次。将癌症发病率与西班牙人群数据进行比较以计算标准化发病率比（SIR），并分别计算癌症和竞争事件的累积发病率。采用多变量Fine - Gray和Cox回归模型评估纵向结局。
共纳入215例患者（男性占68.4%，中位年龄61岁）。肝硬化病因包括酒精性（38%）、乙型或丙型肝炎病毒感染（36%）、酒精加乙型或丙型肝炎病毒感染（9%）以及其他原因（17%）。60%为当前或既往吸烟者。观察到39例癌症（56%为肝癌），而预期为3.3例（SIR 11.7；95%置信区间[CI] 8.6 - 16.1）。10例（4.6%）患者因肝移植被 censored，34例（15.8%）因死亡被censored，构成相关竞争风险。吸烟与总体癌症发病率显著相关（吸烟者：亚分布风险比[SHR] 3.14，95% CI 1.33 - 7.38；既往吸烟者：SHR 2.54，95% CI 1.08 - 5.98）。在多变量回归分析中，病毒病因、Child - Pugh评分（B或C级与A级相比）和吸烟与肝癌相关，吸烟与肝外癌症相关。
与普通人群相比，肝硬化患者患癌风险高11倍。肝癌和非肝癌的风险均增加。这些患者需要对任何类型的癌症进行主动监测并采取戒烟干预措施。
