Lim Jihye, Kim Ye-Jee, Kim Sehee, Shim Ju Hyun
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
PLoS One. 2025 Jul 22;20(7):e0325066. doi: 10.1371/journal.pone.0325066. eCollection 2025.
Few large-scale studies have investigated factors associated with the development of hepatocellular carcinoma (HCC) in patients with autoimmune hepatitis (AIH). This study aimed to determine the risk of HCC in AIH patients and associated risk factors, focusing on metabolic dysfunction-associated steatotic liver disease (MASLD). We analyzed the claims data from the Korean National Health Insurance Service from 2007 to 2020. The study included 7,382 patients with AIH and a control group of 58,538 age- and sex-matched individuals, at a ratio of 1:8. We compared the incidence rates of HCC between these groups and investigated the risk factors of HCC. During a median follow-up of 5.9 years, 160 AIH patients were diagnosed with HCC, resulting in an incidence rate of 3.60 per 1,000 person-years. The matched controls exhibited an incidence rate of 0.48 per 1,000 person-years. After adjustment, AIH patients had a 4.85-fold heightened risk of HCC compared to the control group. Within the AIH cohort, the presence of coexisting MASLD further elevated the risk of HCC, along with other factors such as older age, male sex, and decompensated liver cirrhosis, as observed in a two-year landmark analysis. The presence of concurrent extrahepatic autoimmune diseases did not affect the prognosis, while glucocorticoid treatment was associated with a decreased risk of HCC. Patients with AIH had an increased risk of HCC compared to matched controls, particularly those with coexisting MASLD. In addition to appropriate medical treatment, proactive interventions and lifestyle modifications for concurrent MASLD are recommended for these patients.
很少有大规模研究调查自身免疫性肝炎（AIH）患者发生肝细胞癌（HCC）的相关因素。本研究旨在确定AIH患者发生HCC的风险及相关危险因素，重点关注代谢功能障碍相关脂肪性肝病（MASLD）。我们分析了韩国国民健康保险服务机构2007年至2020年的理赔数据。该研究纳入了7382例AIH患者以及由58538名年龄和性别匹配个体组成的对照组，比例为1:8。我们比较了这些组之间HCC的发病率，并调查了HCC的危险因素。在中位随访5.9年期间，160例AIH患者被诊断为HCC，发病率为每1000人年3.60例。匹配的对照组发病率为每1000人年0.48例。调整后，与对照组相比，AIH患者发生HCC的风险高4.85倍。在AIH队列中，如两年的标志性分析所示，并存MASLD以及年龄较大、男性和失代偿期肝硬化等其他因素会进一步增加HCC的风险。并发肝外自身免疫性疾病的存在不影响预后，而糖皮质激素治疗与HCC风险降低相关。与匹配的对照组相比，AIH患者发生HCC的风险增加，尤其是并存MASLD的患者。除了适当的药物治疗外，建议对这些患者针对并存的MASLD进行积极干预和生活方式调整。
