Gastroenterology and Hepatology Department, Hamad Medical Corporation, Doha, Qatar.
Radiology Department, Hamad Medical Corporation, Doha, Qatar.
J Gastrointest Cancer. 2024 Oct 16;56(1):1. doi: 10.1007/s12029-024-01122-7.
Several studies have shown a higher risk of liver cancer from indeterminate liver nodules, but the exact occurrence and predictors of liver cancer in this group are still unclear. Our aim is to study the development of liver cancer in this population and identify any potential risk factors.
This retrospective study evaluated cirrhotic patients with indeterminate liver nodules from 2013 to 2023.Data from electronic patient records was analyzed to assess the association between HCC and baseline factors. Subgroup exploratory analysis compared characteristics of patients with de novo HCC and those with nodule transformation HCC.
Out of 116 patients with liver nodules, 19 (16%) developed HCC in up to 7.5-year follow-up. Univariate Cox regression analysis showed a significant association between HCC incidence and smoking [hazard ratio (HR) 2.60, 95% Confidence Interval [CI] 1.01-6.74), nodule diameter exceeding 2 cm (HR 5.41, 95% CI 1.45-20.18), and baseline LI-RADS score 3 (HR 3.78, 95% CI 1.36-19.52). Multivariate Cox regression analysis revealed significant independent associations with nodule diameters 1 cm to < 2 cm (adjusted HR 3.35, 95% CI 1.06-10.60) and greater than 2 cm (adjusted HR 5.85, 95% CI 1.10-31.16), as well as with LI-RADS 3 lesions (adjusted HR 3.75, 95% CI 1.16-12.11) with adjusting other potential predictors and covariates.
Our findings show a higher incidence of HCC in patients with indeterminate liver nodules, increasing over time and reaching 30% at seven years. Nodules larger than 1-2 cm or LI-RADS 3 lesions pose increased risk for HCC. Enhanced surveillance is necessary given the lack of clear management guidelines.
多项研究表明，不确定的肝脏结节会增加肝癌风险，但该人群中肝癌的确切发生和预测因素仍不清楚。我们的目的是研究该人群中肝癌的发生情况，并确定任何潜在的危险因素。
本回顾性研究评估了 2013 年至 2023 年期间患有不确定肝脏结节的肝硬化患者。分析电子病历数据以评估 HCC 与基线因素之间的关联。亚组探索性分析比较了新发 HCC 患者和结节转化 HCC 患者的特征。
在 116 例有肝脏结节的患者中，有 19 例（16%）在长达 7.5 年的随访中发展为 HCC。单因素 Cox 回归分析显示，HCC 发生率与吸烟[风险比（HR）2.60，95%置信区间（CI）1.01-6.74]、结节直径超过 2cm（HR 5.41，95% CI 1.45-20.18）和基线 LI-RADS 评分 3（HR 3.78，95% CI 1.36-19.52）显著相关。多因素 Cox 回归分析显示，结节直径 1-2cm（调整后的 HR 3.35，95% CI 1.06-10.60）和大于 2cm（调整后的 HR 5.85，95% CI 1.10-31.16）以及 LI-RADS 3 病变（调整后的 HR 3.75，95% CI 1.16-12.11）与调整其他潜在预测因子和协变量后有显著独立相关性。
我们的研究结果表明，不确定肝脏结节患者的 HCC 发生率较高，随着时间的推移呈上升趋势，在 7 年内达到 30%。直径大于 1-2cm 的结节或 LI-RADS 3 病变提示 HCC 风险增加。由于缺乏明确的管理指南，需要进行强化监测。
