- 现金
- 62111 元
- 精华
- 26
- 帖子
- 30441
- 注册时间
- 2009-10-5
- 最后登录
- 2022-12-28
|
本帖最后由 StephenW 于 2012-11-18 16:10 编辑
Fatty Liver Ups Risk for Liver Cancer By Michael Smith, North American Correspondent, MedPage TodayPublished: November 13, 2012Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Action Points - This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- Explain that a retrospective database analysis found that nonalcoholic fatty liver disease (NAFLD) was an independent risk factor for hepatocellular carcinoma (HCC) among patients over 65 who were diagnosed with HCC without other risk factors.
- Note that more than one-third of patients with NAFLD and associated HCC did not have cirrhosis.
BOSTON -- Non-alcoholic fatty liver disease (NAFLD) is an independent risk factor for hepatocellular carcinoma (HCC), even in the absence of cirrhosis, a researcher reported.
In a retrospective database analysis, 16% of patients with the liver cancer had only NAFLD as a risk factor, according to Rubayat Rahman, MD, of the University of Missouri in Columbia.
Most of those had cirrhosis, but more than a third did not and about 6% had simple steatosis, Rahman reported at the annual meeting here of the American Association for the Study of Liver Diseases.
Moreover, the rate of NAFLD-associated cancer without cirrhosis is growing faster than the rate of disease linked to cirrhosis, Rahman reported.
The findings are "a little scary," commented AASLD president Guadalupe Garcia-Tsao, MD, of Yale University School of Medicine, who discussed the study with reporters.
"This is the most common liver disease and is strongly associated with obesity," she said.
The main implication of the study is that as the obesity epidemic grows, "we're probably not only going to get more cirrhosis and more liver disease, we're probably going to get more liver cancer," Garcia-Tsao said.
Because NAFLD is strongly linked to obesity, it is increasing with the obesity epidemic, Rahman noted, but little is known about the role the condition plays as a risk factor for cancer.
To help fill the gap, she and her collaborator turned to the Surveillance, Epidemiology, and End Results (SEER) and Medicare databases from 1993 through 2007.
All told, the SEER database had records of 17,895 people with proven hepatocellular carcinoma who were at least 65 and did not have multiple risk factors.
Of those, the authors found that 2,863 (16%) only had NAFLD, without any other risk factors or etiologies for cancer, Rahman reported. It was the third most common risk factor, after infections and alcohol-related diseases.
Within that group, the researchers found, 1,832 (64%) had cirrhosis, but a startling 36% (1,031 patients) did not, including 186 patients (6.5% of the total) who only had steatosis.
Moreover, analysis found that cancer rates in both cirrhotic and non-cirrhotic NAFLD patients had been growing, but the yearly incidence rates among those with non-cirrhotic disease are now higher than those among cirrhotic patients.
The average annual number of cases of hepatocellular carcinoma among NAFLD patients was 191 over the period from 1993 through 2007, the researchers found. About two-thirds (122 versus 69) are among patients with cirrhosis.
The comparable yearly averages for the period 1993 through 2000 were 174 overall, 123 in cirrhotic patients, and 51 in those without cirrhosis, Rahman reported.
But in the latter half of the study period – 2001 through 2007 – that pattern changed: 210 a year overall, with 122 among cirrhotic patients and 88 among the non-cirrhotic.
The overall change and the change in incidence among non-cirrhotic patients were both significant (P<0.01), but the difference among cirrhotic patients did not reach significance, Rahman reported.
Among the NAFLD HCC cases, 5-year survival was better (P<0.001) in noncirrhotic than cirrhotic cases (22% versus 17%), the group noted.
The researchers did not report any external support for the study and reported they had no conflicts.
Garcia-Tsao reported no relevant conflicts.
Primary source: American Association for the Study of Liver Diseases
Source reference:
Rahman RN, Ibdah JA "Nonalcoholic fatty liver disease without cirrhosis is an emergent and independent risk factor of hepatocellular carcinoma: A population based study" AASLD 2012; Abstract 97.
Michael Smith
North American Correspondent
North American Correspondent for MedPage Today, is a three-time winner of the Science and Society Journalism Award of the Canadian Science Writers' Association. After working for newspapers in several parts of Canada, he was the science writer for the Toronto Star before becoming a freelancer in 1994. His byline has appeared in New Scientist, Science, the Globe and Mail, United Press International, Toronto Life, Canadian Business, the Toronto Star, Marketing Computers, and many others. He is based in Toronto, and when not transforming dense science into compelling prose he can usually be found sailing.
|
|