肝癌在肝硬化与非肝硬化的肝脏

StephenW

Eur J Gastroenterol Hepatol. 2015 Dec 1. [Epub ahead of print]
Hepatocellular carcinoma in cirrhotic versus noncirrhotic livers: results from a large cohort in the Netherlands.van Meer S1, van Erpecum KJ, Sprengers D, Coenraad MJ, Klümpen HJ, Jansen PL, IJzermans JN, Verheij J, van Nieuwkerk CM, Siersema PD, de Man RA.
Author information

• 1aDepartment of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht Departments of bGastroenterology and Hepatology cSurgery, Erasmus Medical Center, Rotterdam dDepartment of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden Departments of eMedical Oncology fGastroenterology and Hepatology gPathology, Academic Medical Center Amsterdam hDepartment of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands.
  

AbstractOBJECTIVES: Hepatocellular carcinoma (HCC) usually occurs in patients with cirrhosis, but can also develop in noncirrhotic livers. In the present study we explored associated risk factors for HCC without cirrhosis and compared patient and tumor characteristics and outcomes in HCC patients with and without underlying cirrhosis.
METHODS: Patients with HCC diagnosed in the period 2005-2012 in five Dutch academic centers were evaluated. Patients were categorized according to the presence of cirrhosis on the basis of histology or combined radiological and laboratory features.
RESULTS: In total, 19% of the 1221 HCC patients had no underlying cirrhosis. Noncirrhotic HCC patients were more likely to be female and to have nonalcoholic fatty liver disease or no risk factors for underlying liver disease, and less likely to have hepatitis C virus or alcohol-related liver disease than did cirrhotic HCC patients. HCCs in noncirrhotic livers were more often unifocal (67 vs. 48%), but tumor size was significantly larger (8 vs. 4 cm). Despite the larger tumors, more patients underwent resection (50 vs. 10%) and overall survival was significantly better than in cirrhotics. In multivariate analyses, absence of cirrhosis [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.38-0.63] and presence of hepatitis B (HR 0.68, 95% CI 0.51-0.91) were independent predictors for lower mortality, whereas hepatitis C virus was associated with higher mortality (HR 1.32, 95% CI 1.01-1.65).
CONCLUSION: HCC without cirrhosis was strongly associated with female sex and presence of nonalcoholic fatty liver disease or no risk factors for underlying liver disease. In absence of cirrhosis, resections were more often performed, with better survival despite larger tumor size.

StephenW

欧元J Gastroenterol肝脏病杂志。 2015年1月[EPUB提前打印]
肝癌肝硬化与肝硬化的肝：从一个大队列在荷兰的结果。
面包车米尔S1，面包车Erpecum KJ，Sprengers研发，Coenraad MJ，KlümpenHJ，扬森PL，IJzermans JN，VerheijĴ，面包车Nieuwkerk CM，Siersema PD，德·曼RA。
作者信息

    胃肠病学和肝病，大学医学中心的乌得勒支，bGastroenterology乌得勒支部门和肝病cSurgery，Erasmus医学中心消化科鹿特丹dDepartment和肝病，莱顿大学医学中心，eMedical肿瘤fGastroenterology和肝病gPathology莱顿部门，学术医学中心的阿姆斯特丹hDepartment的1aDepartment胃肠病学和肝病，VU大学医学中心，阿姆斯特丹，荷兰。

抽象
目的：

肝细胞癌（HCC）通常发生在肝硬化患者，也可以开发肝硬化的肝脏。在本研究中，我们探讨了相关的危险因素，肝癌无肝硬化和比较患者和肿瘤的特点和成果，在肝癌患者和无潜在的肝硬化。
方法：

HCC患者在诊断期间2005-2012五年荷兰学术中心进行了评价。患者根据肝硬化组织学的基础或组合放射性和实验室特征上是否存在分类。
结果：

总的来说，1221 HCC患者19％的人没有底层肝硬化。非肝硬化肝癌患者更可能是女性，并有非酒精性脂肪肝疾病或无危险因素为基础的肝脏疾病，并不太可能有C型肝炎病毒或酒精相关肝病比没有肝硬化HCC患者。在非肝硬化肝脏肝癌更经常单焦（67对48％），但肿瘤大小为显著较大（8比4厘米）。尽管肿瘤较大，更多的患者接受了切除术（50对10％）和总生存率低于肝硬化显著更好。在多变量分析，没有肝硬化的危险比（HR）0.49，95％可信区间（CI）0.38-0.63]和乙肝的存在（HR 0.68，95％CI 0.51-0.91）是用于降低死亡率的独立预测因子，而丙型肝炎病毒与较高的死亡率（HR 1.32，95％CI 1.01-1.65）相关。
结论：

肝细胞癌无肝硬化是紧密联系在一起的女性性别和非酒精性脂肪肝疾病或危险因素的潜在肝脏疾病的存在有关。在没有肝硬化，切除更经常进行，以更好地生存，尽管较大的肿瘤大小。