肝细胞癌在慢性乙型肝炎病毒感染患者中无肝硬化

StephenW

Hepatocellular carcinoma in the absence of cirrhosis in patients with chronic hepatitis B virus infection
Maneerat ChayanupatkulcorrespondencePress enter key for correspondence informationemailPress enter key to Email the author
, Ronald Omino
, Sahil Mittal
, Jennifer R. Kramer
, Peter Richardson
, Aaron P. Thrift
, Hashem B. El-Serag
, Fasiha Kanwal
Article has an altmetric score of 12
DOI: http://dx.doi.org/10.1016/j.jhep.2016.09.013 |

Background & AimsCirrhosis related to chronic hepatitis B (CHB) is a major risk factor for hepatocellular carcinoma (HCC). The extent to which HCC occurs in U.S. in the absence of cirrhosis in CHB remains unclear.
MethodsWe identified CHB patients who were diagnosed with HCC in the national Veterans Administration (VA) between 2001 and 2013. We defined presence and absence of cirrhosis at the time of HCC diagnosis using explicit histological, radiological, endoscopic, and laboratory criteria. We used multivariable regression analysis to identify demographic and clinical characteristics associated with CHB-related HCC in the absence of cirrhosis. We also examined liver transplant-free survival in CHB-HCC patients with and without cirrhosis.
ResultsAmong 8539 CHB patients, 317 developed HCC of whom 30 (9.5%) did not have any evidence of cirrhosis at the time of HCC diagnosis. Compared to HCC patients with cirrhosis, HCC patients without cirrhosis were more likely to be non-white (African American, OR = 6.78; 95% CI 2.05–22.4; Asian, OR 11.6, 95% CI 2.63–50.8), have a family history of HCC (OR 32.9, 95% CI 3.76–288), and hypertension (OR 3.15, 95% CI 1.02–9.75). There was no significant difference in the transplant-free survival between CHB-HCC patients with and without cirrhosis (hazard ratio 0.68, 95% CI 0.43–1.09).
ConclusionsFewer than 10% of U.S. based CHB-related HCC patients did not have cirrhosis. Race and family history of HCC were the main risk factors for HCC in the absence of cirrhosis in CHB. These factors may help guide the decision to initiate HCC surveillance in CHB patients without cirrhosis.
Lay summaryPatients with chronic hepatitis B who are African American, or Asian, older than 40 years of age with family members with liver cancer or high blood pressure are at a higher risk of developing liver cancer in the absence of cirrhosis. These patients should be included in the screening program for liver cancer.

Keywords:                Hepatocellular carcinoma, Chronic hepatitis B, Cirrhosis, Epidemiology, Liver cirrhosis, Risk factors, Liver transplantation

StephenW

肝细胞癌在慢性乙型肝炎病毒感染患者中无肝硬化
Manuelat Chayanupatkulcorrespondence按回车键输入通讯信息
，Ronald Omino
，Sahil Mittal
，Jennifer R.Kramer
，Peter Richardson
，Aaron P. Thrift
，Hashem B.El-Serag
，Fasiha Kanwal
文章的评分为12分
DOI：http://dx.doi.org/10.1016/j.jhep.2016.09.013 |

背景与目的

与慢性乙型肝炎（CHB）相关的肝硬化是肝细胞癌（HCC）的主要危险因素。在CHB中没有肝硬化的情况下，HCC在美国发生的程度仍不清楚。
方法

我们确定在2001年至2013年之间在国家退伍军人管理局（VA）诊断为HCC的CHB患者。我们使用明确的组织学，放射学，内窥镜和实验室标准，在HCC诊断时定义肝硬化的存在和不存在。我们使用多变量回归分析来确定与肝硬化无CHB相关肝癌相关的人口学和临床特征。我们还检查了CHB-HCC患者的肝移植生存与无肝硬化。
结果

在8539例CHB患者中，317例发展为HCC，其中30例（9.5％）在HCC诊断时没有肝硬化的证据。与肝硬化HCC患者相比，没有肝硬化的HCC患者更可能是非白人（非裔美国人，OR = 6.78; 95％CI 2.05-22.4;亚洲，OR 11.6,95％CI 2.63-50.8） HCC病史（OR 32.9,95％CI 3.76-288）和高血压（OR 3.15,95％CI 1.02-9.75）。 CHB-HCC患者与无肝硬化患者的移植生存率无显着性差异（风险比0.68,95％CI 0.43-1.09）。
结论

少于10％的美国CHB相关的HCC患者没有肝硬化。 HCC的种族和家族史是CHB中没有肝硬化的HCC的主要风险因素。这些因素可能有助于指导在没有肝硬化的CHB患者中开始HCC监测的决定。
放置摘要

慢性乙型肝炎患者是非裔美国人或亚洲人，年龄大于40岁，家族成员患有肝癌或高血压，在没有肝硬化的情况下发生肝癌的风险较高。这些患者应包括在肝癌的筛选程序中。
关键词：
肝细胞癌，慢性乙型肝炎，肝硬化，流行病学，肝硬化，危险因素，肝移植

neilhbver

看来b超和甲胎蛋白要一年检查一次。国内三家医院医生也是懂得这个道理的

可与言者

坚持健康生活方式，乙肝病毒虽然已经不能避免了，但是高血压还是能够尽量避免的。

tacolynn

我婆婆就是，肝癌占位13厘米，没有肝硬化。

newchinabok

新药研发周期长，成功率低，十年能研发出一，二个新药都是幸事