Tsukuma H, Hiyama T, Tanaka S, Nakao M, Yabuuchi T, Kitamura T, Nakanishi K, Fujimoto I, Inoue A, Yamazaki H
Department of Field Research, Center for Adult Diseases, Osaka, Japan.
N Engl J Med. 1993 Jun 24;328(25):1797-801. doi: 10.1056/NEJM199306243282501.
To detect potentially curable cases of hepatocellular carcinoma, outpatients with chronic hepatitis or compensated liver cirrhosis who were seen at the Center for Adult Diseases (Osaka, Japan) were examined periodically by means of ultrasonography and measurement of serum alpha-fetoprotein. Risk factors for hepatocellular carcinoma were identified with a Cox proportional-hazards model.
A total of 917 patients, 40 to 69 years old, were registered from May 1987 to March 1991. By the end of September 1991, liver cancer had developed in 54. The three-year cumulative risk of liver cancer was 12.5 percent for 240 patients with liver cirrhosis at enrollment and 3.8 percent for 677 patients with chronic hepatitis. Cox regression analysis showed that the risk of liver cancer was increased almost sevenfold in patients with hepatitis B surface antigen (rate ratio, 6.92; 95 percent confidence interval, 2.92 to 16.39) and fourfold in patients with hepatitis C antibody (rate ratio, 4.09; 95 percent confidence interval, 1.30 to 12.85). A high alpha-fetoprotein value at enrollment was also a risk marker for liver cancer.
Patients with hepatitis C virus infection have a greatly increased risk of liver cancer. Further studies are required to clarify the roles of other risk factors, including drinking and smoking habits.
为了检测肝细胞癌可能治愈的病例，对在日本大阪成人疾病中心就诊的慢性肝炎或代偿性肝硬化门诊患者，通过超声检查和血清甲胎蛋白测量进行定期检查。采用Cox比例风险模型确定肝细胞癌的危险因素。
1987年5月至1991年3月共登记了917例年龄在40至69岁之间的患者。到1991年9月底，有54例发生了肝癌。入组时240例肝硬化患者的三年肝癌累积风险为12.5%，677例慢性肝炎患者为3.8%。Cox回归分析显示，乙肝表面抗原阳性患者的肝癌风险增加近7倍（率比为6.92；95%置信区间为2.92至16.39），丙肝抗体阳性患者增加4倍（率比为4.09；95%置信区间为1.30至12.85）。入组时甲胎蛋白值高也是肝癌的一个风险标志物。
丙型肝炎病毒感染患者患肝癌的风险大大增加。需要进一步研究以阐明包括饮酒和吸烟习惯在内的其他危险因素的作用。
