EASL2015: 脂肪性肝病涌动肝癌的原因

StephenW

Fatty Liver Disease Surging as Liver Cancer Cause

Miriam E. Tucker April 25, 2015

   

VIENNA — Nonalcoholic fatty liver disease is emerging as a major cause of hepatocellular carcinoma in the United States, a new study shows.

In fact, from 2004 to 2009, the annual increase in hepatocellular carcinoma in fatty liver disease patients was approximately 5%.

Survival is shorter for patients with fatty liver who develop cancer than it is for patients with hepatitis B or hepatitis C who develop hepatocellular carcinoma, said Zobair Younossi, MD, from the Inova Health System in Falls Church, Virginia.

Tumor stage is also more advanced at diagnosis in patients with fatty-liver-associated carcinoma, and liver transplantation is less common, he reported.

"Given the epidemic of nonalcoholic fatty liver, the burden of disease-related complications is expected to rise," Dr Younossi said here at the Liver Congress 2015.

Fatty liver disease affects about 25% of the population in the United States. About 2% to 3% of the population has the progressive form of the disease — nonalcoholic steatohepatitis.

"I suspect it is the nonalcoholic steatohepatitis patients who are primarily at risk for adverse outcomes," Dr Younossi told Medscape Medical News. "In 2015, the only way to confidently establish the diagnosis of steatohepatitis is by a liver biopsy. Because biopsy is invasive, it is done in the small minority of patients. Therefore, a large number of patients with nonalcoholic steatohepatitis are undiagnosed," he explained.

"And there may not be a recognition that patients with advanced fibrosis are at risk for hepatocellular carcinoma," he added.

His recommendation is to "determine if a patient with fatty liver has steatohepatitis-related advanced fibrosis or cirrhosis. If so, they should be screened for hepatocellular carcinoma every 6 months."

More Deaths

From 2004 to 2009, Dr Younossi and colleagues identified 5748 hepatocellular carcinoma patients and 17,244 control subjects without cancer from the Surveillance, Epidemiology, and End Results (SEER)–Medicare database.

The liver cancer was related to hepatitis C in 48% of the cases, to fatty liver in 26%, to alcoholic liver disease in 14%, to hepatitis B in 8%, and to autoimmune hepatitis or biliary cirrhosis in 4%.

This is a very important study because of the very large number of patients.


The number of cases of hepatocellular carcinoma increased each year during the study period. Annual increases in fatty-related cancers were proportionate to increases in hepatocellular carcinoma related to other causes.
Patients with fatty-liver-related cancer were older at diagnosis than patients with cancer related to hepatitis B or C (72 vs 66 years), were more likely to be white, and were more likely to have unstaged or advanced tumors. In addition, average survival was 4 months shorter in patients with fatty-liver-related cancer (P < .05).

On multivariate analysis, being male and being of a nonwhite or nonblack race were independently associated with cancer, as were having a high Charlson Comorbidity Index score and the presence of hepatitis B, hepatitis C, or fatty liver.

More patients with hepatocellular carcinoma related to fatty liver than related to hepatitis B or C died within 1 year of diagnosis (62% vs 50%; P < .05). The most common cause of death was cancer or liver disease (96.3%), followed by cardiac death (3.7%).

For patients with cancer, factors associated with 1-year mortality were being older, having a lower income, having an unstaged tumor, being eligible for Medicare, having end-stage renal disease, and having fatty liver. Factors protective against 1-year mortality were having undergone liver transplantation and having a localized tumor.

"This is a very important study because of the very large number of patients," said session moderator Helena Cortez-Pinto, MD, from the University Hospital of Lisbon in Portugal.

Fatty-liver-associated cancer is particularly challenging to detect because it can occur in the absence of cirrhosis. "You can't do surveillance of all patients with fatty liver; that would be a very high burden," she told Medscape Medical News.

But the possibility should be kept in mind, particularly with obese patients. "We have to recognize that there is the possibility of patients with fatty liver developing cancer even in the absence of cirrhosis. We don't know exactly how frequent this is, but it exists," Dr Cortez-Pinto explained. "If there is any kind of suspicion, refer patients for further investigation."

The mortality rate for fatty-liver-associated cancer is rather surprising, and hasn't been seen in all studies, said Dr Cortez-Pinto. The finding is likely the result of the poor cancer surveillance in fatty liver patients. "If a tumor is discovered during cirrhosis surveillance, it is more likely to be monitored," she pointed out.

Dr Younossi said he agrees with that. "Fatty liver is associated with shorter survival because by the time these patients present clinically, they have advanced cancer. The reason may be that they don't undergo screening or that screening ultrasound fails to detect small cancers with fatty liver visceral obesity."

And, he added, "because of their comorbidities, they don't undergo liver transplant."

Dr Younossi is a consultant to Gilead, BMS, Intercept, GSK, AbbVie, and Salix. Dr Cortez-Pinto reports receiving consulting fees from Intercept and Janssen.

European Association for the Study of the Liver (EASL) International Liver Congress 2015. Presented April 24, 2015.

StephenW

脂肪性肝病涌动肝癌的原因

E.仪塔克2015年4月25日

   

维也纳 - 非酒精性脂肪性肝病正逐渐成为在美国肝癌的主要原因，一项新的研究显示。

事实上，2004年至2009年，在脂肪肝的患者每年增加肝细胞癌约为5％。

生存时间较短的谁患癌症比是治疗乙肝或丙肝谁开发肝癌，脂肪肝患者，说祖贝尔Younossi，MD，从INOVA的卫生系统在弗吉尼亚州Falls Church。

肿瘤阶段也更先进诊断患者的脂肪肝相关癌，肝移植是不太常见的，他报告。

“鉴于非酒精性脂肪肝的流行，疾病相关并发症的负担预计将上升，”Younossi博士在此间举行的肝病会议2015年说。

脂肪肝疾病影响约25％的美国人口。约2％至3％的人口具有该疾病的进行性形式 - 非酒精性脂肪性肝炎。

“我怀疑这是在非酒精性脂肪性肝炎患者谁是主要的风险不良后果，”Younossi博士向Medscape医学新闻。 “在2015年，满怀信心地树立脂肪性肝炎的诊断的唯一方法是肝活检。因为活检是侵入性的，它在少数患者已经完成。因此，大量的非酒精性脂肪性肝炎的确诊，”他解释。

“而且有可能不是一种认识，即患者的肝纤维化是在危险中为肝癌，”他补充说。

他的建议是，以“确定是否患有脂肪肝患者有脂肪性肝炎相关的肝纤维化或肝硬化。如果是这样，就应该筛查肝癌每6个月。”

更多的死亡

从2004年到2009年，Younossi博士和他的同事确定了5748肝癌患者，并从监测，流行病学和最终结果（SEER）-Medicare数据库17244对照组无癌。

所述肝癌是有关丙型肝炎中的情况下48％，脂肪肝的26％，酒精性肝病中的14％，B型肝炎在8％以上，自身免疫性肝炎，或在4％的胆汁性肝硬化。

这是因为，在非常大的数量的患者的一个非常重要的研究。


肝癌病例数在研究期间，每年都在提高。每年增加的脂肪有关的癌症是成比例的增加肝癌相关的其他原因。
例脂肪肝相关癌症患者年龄在诊断比癌症患者有关乙型或丙型肝炎（72 VS66年），更可能是白色的，而更可能具有不分级或晚期肿瘤。此外，平均生存期为4个月缩短患者的脂肪肝有关的癌（P <0.05）。

多变量分析显示，作为男性，是一个非白人和非黑人种族是独立的与癌症相关，如被具有高察尔森合并症指数得分和乙肝，丙肝，或脂肪肝的存在。

更多的肝癌患者与脂肪肝不是涉及到乙型或丙型肝炎1年诊断内死亡（62％比50％，P <0.05）。死亡的最常见的原因是癌症或肝病（96.3％），其次是心脏死亡（3.7％）。

对于癌症患者，1年死亡率相关因素是年龄的增长，具有较低的收入，有不分级的肿瘤，是享受Medicare，有终末期肾病，并有脂肪肝。保护性因素对1年死亡率已经历肝移植以及具有本地化的肿瘤。

“这是因为非常多的患者的一个非常重要的研究，说：”会议的主持人海伦娜科特斯 - 平托，MD，从里斯本大学医院在葡萄牙。

脂肪肝相关癌症是特别具有挑战性的检测，因为它可以发生在没有肝硬化。 “你不能做所有的脂肪肝患者的监督，这将是一个非常高的负担，”她告诉WebMD医学新闻。

但可能性应该牢记，尤其是肥胖患者。 “我们必须认识到，有一种脂肪肝患者患癌症甚至在没有肝硬化的可能性。我们不知道究竟是如何频繁，这是的，但它的存在，”医生科尔特斯 - 平托解释。 “如果有任何怀疑，请患者做进一步的调查。”

死亡率脂肪肝相关的癌症是相当惊人的，并没有被视为在所有的研究中，医生科尔特斯 - 平托说。这一发现很可能在脂肪肝患者的贫困癌症监测的结果。 “如果肿瘤是在肝硬化监测发现，它更容易被监测，”她指出。

Younossi博士说，他同意了。 “脂肪肝是用较短的存活，因为由时间这些患者呈现临床上，他们有先进的癌症有关，原因可能是，它们不接受检查或筛查超声未能检测脂肪肝内脏肥胖小的癌症”。

而且，他补充说，“因为他们的合并症，他们不接受肝脏移植手术。”

Younossi博士是一位顾问，Gilead公司，BMS，拦截，GSK，AbbVie和柳。医生科尔特斯 - 平托的报告从截取和扬森收到的咨询费。

欧洲协会为肝脏（EASL）国际肝病会议2015年的研究中提出2015年4月24日。