Trevisani F, D'Intino P E, Caraceni P, Pizzo M, Stefanini G F, Mazziotti A, Grazi G L, Gozzetti G, Gasbarrini G, Bernardi M
Clinica Chirurgica II, University of Bologna, Italy.
Cancer. 1995 May 1;75(9):2220-32. doi: 10.1002/1097-0142(19950501)75:9<2220::aid-cncr2820750906>3.0.co;2-4.
It is not known whether the prevalence of hepatocarcinogenic factors differs between cirrhotic and noncirrhotic patients with hepatocellular carcinoma (HCC) or whether the clinical presentation of HCC in these two groups differs.
The prevalence of the putative etiologic factors of HCC and its clinical presentation in 373 patients with cirrhosis and 102 without cirrhosis seen from 1981 to 1992 were evaluated.
Hepatitis C virus infection (76 vs. 48%, P = 0.003) and both current (22.5 vs. 10%, P = 0.007) and past (50.5 vs. 34.5%, P = 0.045) hepatitis B virus infections were more common in cirrhotic than in noncirrhotic patients with HCC. The absence of exposure to both viruses was much less frequent in the former (7 vs. 40%, P < 0.001). Heavy alcohol intake prevailed in patients with cirrhosis (30 vs. 16.5%, P = 0.01). Alpha-fetoprotein elevation was more common in cirrhotic patients (63% vs. 31%, P < 0.001); however, the prevalence of diagnostic (> 400 ng/ml) levels did not differ significantly (24 vs. 17%) between the two groups. Extrahepatic extension of HCC was more common in noncirrhotic patients (20.5 vs. 6.5%, P < 0.001) and its independent predictors were poor cancer differentiation and absence of cirrhosis. "Asymptomatic" cancers were more frequently encountered with cirrhosis. Abdominal pain was the most common presenting symptom in both groups. Signs of hepatic decompensation prevailed in cirrhotic patients, whereas a "toxic syndrome" dominated the clinical picture of the noncirrhotic patients.
Hepatitis viruses are associated more with carcinogenesis of the cirrhotic than of the noncirrhotic liver. Alpha-fetoprotein is not a sensitive neoplastic marker, particularly in noncirrhotic patients. In the latter, HCC appears more advanced at diagnosis and symptoms of neoplastic toxicity are prominent.
目前尚不清楚肝细胞癌（HCC）的致癌因素在肝硬化和非肝硬化患者中的患病率是否存在差异，以及这两组患者中HCC的临床表现是否不同。
对1981年至1992年间收治的373例肝硬化患者和102例非肝硬化患者中HCC的假定病因因素及其临床表现进行了评估。
丙型肝炎病毒感染（76%对48%，P = 0.003）以及当前（22.5%对10%，P = 0.007）和既往（50.5%对34.5%，P = 0.045）乙型肝炎病毒感染在肝硬化的HCC患者中比非肝硬化患者更常见。在前者中，两种病毒均未暴露的情况要少得多（7%对40%，P < 0.001）。大量饮酒在肝硬化患者中更为普遍（30%对16.5%，P = 0.01）。甲胎蛋白升高在肝硬化患者中更为常见（63%对31%，P < 0.001）；然而，两组之间诊断水平（> 400 ng/ml）的患病率无显著差异（24%对17%）。HCC的肝外扩展在非肝硬化患者中更为常见（20.5%对6.5%，P < 0.001），其独立预测因素为癌症分化差和无肝硬化。“无症状”癌症在肝硬化患者中更常见。腹痛是两组中最常见的首发症状。肝硬化患者中肝失代偿体征更为普遍，而非肝硬化患者的临床表现则以“中毒综合征”为主。
肝炎病毒与肝硬化肝脏的致癌作用比与非肝硬化肝脏的致癌作用关联更大。甲胎蛋白不是一个敏感的肿瘤标志物，尤其是在非肝硬化患者中。在后者中，HCC在诊断时似乎更为晚期，肿瘤毒性症状较为突出。
