肝硬化患者肝癌风险低

StephenW

HCC risk low among patients with cirrhosis

West J, et al. Aliment Pharmacol Ther. 2017;doi:10.1111/apt.13961.
February 2, 2017

The risk for hepatocellular carcinoma was low among patients with cirrhosis, with a 10-year incidence of 4% or lower, according to the results of a U.K. population-based cohort study.


While low overall, investigators found the incidence of HCC was highest among patients with cirrhosis due to chronic viral hepatitis compared with other etiologies.

“This very low incidence of HCC occurrence in people with cirrhosis caused by alcohol or of unknown origin suggests that surveillance for HCC among these groups is likely to benefit patients little,” Joe West, PhD, of the division of epidemiology and public health at the University of Nottingham in the U.K., said in a press release. “As surveillance incurs substantial cost, it is therefore unlikely to represent value for money for the NHS. There may well be other ways of spending this money that would benefit patients far more.”

West and colleagues identified 3,107 patients diagnosed with cirrhosis between 1987 and 2006 using the U.K.’s General Practice Research Database, and assessed the incidence of HCC using linked national cancer registry data spanning 1971 to 2006. The patients contributed 12,977 person-years to the study, 56% had alcoholic cirrhosis, 12% had cirrhosis due to chronic viral hepatitis, 11% had cirrhosis due to autoimmune or metabolic disease, and 21% had cirrhosis due to an unknown cause.

Fifty-one incident cases of HCC occurred, corresponding to an incidence rate of 3.9 per 1,000 person-years. Absolute rates of HCC, “as expected … were higher in men compared to women, at older ages and among those with a chronic viral etiology,” the researchers wrote.

After adjusting for confounders, the adjusted relative risk for HCC was three times higher in patients with a chronic viral etiology compared with those with an alcohol-related etiology (HR = 3.22; 95% CI, 1.56-6.65).

“Those with metabolic or autoimmune diseases were also at increased risk compared to the alcoholic group, whereas those with the assignation of cryptogenic cirrhosis had a similar incidence of HCC to the alcohol group,” the researchers wrote.

Finally, they estimated that 10-year cumulative HCC incidences were 1.2% for alcoholic cirrhosis, 4% for cirrhosis due to chronic viral hepatitis, 3.2% for cirrhosis related to autoimmune or metabolic disease, and 1.1% for cirrhosis due to an unknown cause.

“Although there may be particular patients with combinations of risk factors where surveillance is warranted, our results imply that universal surveillance should not be undertaken on the basis of alcoholic etiology or in cryptogenic cirrhosis and is likely to be of debatable value in autoimmune and metabolic causes of cirrhosis,” they concluded. – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.

StephenW

肝硬化患者肝癌风险低

West J，et al。 Aliment Pharmacol Ther。 2017; doi：10.1111 / apt.13961。
2017年2月2日

根据英国基于人群的队列研究的结果，肝硬化患者肝细胞癌的风险较低，10年发病率为4％或更低。


虽然整体较低，研究人员发现肝硬化患者由于慢性病毒性肝炎与其他病因相比，肝癌的发病率最高。

“在酒精或未知来源的肝硬化患者中发生肝癌的发生率非常低，这表明，这些组之间的HCC监测很可能对患者有益，”Joe West博士，流行病学和公共卫生部门英国诺丁汉大学在一份新闻稿中说。 “由于监控招致大量成本，因此不可能代表国民保健服务的货币价值。可能有其他方式花费这笔钱，这将使患者受益更多。

West和同事利用英国通用实践研究数据库确定了1987年至2006年期间诊断为肝硬化的3,107例患者，并使用1971 - 2006年连接的国家癌症登记数据评估了HCC的发病率。患者为研究提供了12,977人 - 年，56％患有酒精性肝硬化，12％由于慢性病毒性肝炎引起肝硬化，11％由于自身免疫或代谢性疾病引起肝硬化，21％由于未知原因引起肝硬化。

发生了51例HCC的事件，相应的发病率为3.9 / 1000人年。研究人员写道，绝对率的HCC，与男性相比，男性高于女性，在老年人和慢性病毒性病因。

在调整混杂因素后，与具有酒精相关病因（HR = 3.22; 95％CI，1.56-6.65）的患者相比，经调整的HCC的相对风险是具有慢性病毒性病因的患者的三倍。

研究人员写道：“与酒精组相比，那些患有代谢性疾病或自身免疫性疾病的患者的风险增加，而隐源性肝硬化患者的HCC发生率与酒精组相似。

最后，他们估计10年累积肝癌发病率为1.2％的酒精性肝硬化，4％的肝硬化由于慢性病毒性肝炎，3.2％的肝硬化相关的自身免疫性或代谢性疾病，1.1％的肝硬化由于未知的原因。

“虽然可能有特定的患者具有危险因素的组合，需要进行监测，但我们的结果意味着普遍监测不应该在酒精病因或隐源性肝硬化的基础上进行，并且在自身免疫和代谢原因中可能是有争议的价值的肝硬化，“他们总结。 - 由亚当Leitenberger

披露：研究人员报告无相关财务披露。

tacolynn

这些研究也不知道该信谁的了！之前不少研究都说肝硬化癌变几率高呢

StephenW

回复 tacolynn 的帖子

这是英国 病人. 用作参考.