隐源性与乙型肝炎病因的肝细胞癌比较：3079例超过30年的研

StephenW

Dig Dis Sci. 2018 Oct 16. doi: 10.1007/s10620-018-5331-x. [Epub ahead of print]
Comparison of Hepatocellular Carcinoma in Patients with Cryptogenic Versus Hepatitis B Etiology: A Study of 1079 Cases Over 3 Decades.
Liew ZH1, Goh GB1, Hao Y2, Chang PE1, Tan CK3.
Author information

1
    Department of Gastroenterology and Hepatology, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore.
2
    Health Services Research Unit, Division of Medicine, Singapore General Hospital, Singapore, Singapore.
3
    Department of Gastroenterology and Hepatology, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore. [email protected].

Abstract
BACKGROUND:

Traditionally in Asia, hepatitis B (HBV) accounts for the majority of hepatocellular carcinoma (HCC), but increasingly, non-viral or nonalcoholic steatohepatitis (NASH) etiology may play a more prominent role with current socioeconomic changes. There remains a paucity in data comparing NASH-HCC to HBV-related HCC. In this study, we explored the differences in clinical characteristics between HBV- and cryptogenic-related HCC.
METHODS:

Patients with HCC seen in the Department of Gastroenterology and Hepatology, Singapore General Hospital were enrolled in an ongoing database since 1980. Patients with HCC attributed to HBV or cryptogenic etiology were identified. Comparison of clinical characteristics was performed between the two groups.
RESULTS:

There were 916 HBV-HCC patients and 163 cryptogenic HCC patients, accounting for 70.9% and 12.6% of the total HCC cases (1292 patients), respectively. Out of the total cohort enrolled from 1980 to 2005, the ratio of cryptogenic to HBV patients was 1:6.7, while from 2006 to the current year, the ratio of cryptogenic to HBV patients has increased significantly to 1:3.9. Relative to patients with HBV, cryptogenic HCC patients were older (67.6 vs. 59.4 years old; p < 0.001), had lower proportion of male patients (69.9% vs. 83.8%; p < 0.001), and had higher incidence of smoking (32.2% vs. 25.8%; p = 0.008). HBV group had higher alanine transaminase (60.9 ± 85.7 U/L vs. 48.0 ± 52.1 U/L; p = 0.003), hemoglobin (12.7 ± 2.28 g/dL vs. 12.0 ± 2.46 g/dL, p < 0.001), albumin (32.9 ± 6.8 g/L vs. 31.3 ± 7.7 g/L; p = 0.007), and prothrombin time (13.2 ± 2.95 s vs. 12.7 ± 2.01 s, p = 0.023), as compared to the cryptogenic group. Cryptogenic HCC patients presented more frequently with unifocal HCC (55.2% vs. 46.5%; p = 0.002). There was no difference in the proportions of patients receiving surgical resection in both groups (23.5% in HBV group vs. 17.9% in cryptogenic group; p = 0.202). Cox regression analysis revealed no survival difference between cryptogenic-related HCC and HBV-related HCC (p = 0.367).
CONCLUSION:

Temporal trends suggest that HCC attributed to HBV is on the decline, while cryptogenic- or NASH-related HCC is an emerging clinical entity. A paradigm shift in approach to screening, surveillance, and management of HCC may be required in view of the changing landscape of HCC epidemiology into an increasing non-viral etiology.
KEYWORDS:

Cryptogenic; Hepatitis B; Hepatocellular carcinoma; Singapore

PMID:
    30327962
DOI:
    10.1007/s10620-018-5331-x

StephenW

Dig Dis Sci。 2018年10月16日doi：10.1007 / s10620-018-5331-x。 [提前打印]
隐源性与乙型肝炎病因的肝细胞癌比较：3079例超过30年的研究。
Liew ZH1，Goh GB1，Hao Y2，Chang PE1，Tan CK3。
作者信息

1
    新加坡综合医院，新加坡综合医院，消化内科和肝脏病学系，20 College Road，Singapore，169856，新加坡。
2
    新加坡新加坡综合医院医学科卫生服务研究室。
3
    新加坡综合医院，新加坡综合医院，消化内科和肝脏病学系，20 College Road，Singapore，169856，新加坡。 [email protected]。

抽象
背景：

传统上在亚洲，乙型肝炎（HBV）占肝细胞癌（HCC）的大多数，但随着当前社会经济的变化，非病毒性或非酒精性脂肪性肝炎（NASH）病因学可能会发挥越来越重要的作用。将NASH-HCC与HBV相关的HCC进行比较的数据仍然很少。在这项研究中，我们探讨了HBV和隐源性相关HCC之间临床特征的差异。
方法：

自1980年以来，在新加坡综合医院消化内科和肝病科就诊的HCC患者被纳入正在进行的数据库中。确定了归因于HBV或隐源性病因的HCC患者。在两组之间进行临床特征的比较。
结果：

共有916例HBV-HCC患者和163例隐源性HCC患者，分别占总HCC病例（1292例）的70.9％和12.6％。在1980年至2005年登记的总队列中，隐源性与HBV患者的比例为1：6.7，而从2006年到当年，隐源性与HBV患者的比例显着增加至1：3.9。相对于HBV患者，隐源性HCC患者年龄较大（67.6对59.4岁; p <0.001），男性患者比例较低（69.9％对83.8％; p <0.001），吸烟发生率较高（ 32.2％对25.8％; p = 0.008）。 HBV组丙氨酸转氨酶较高（60.9±85.7 U / L vs. 48.0±52.1 U / L; p = 0.003），血红蛋白（12.7±2.28 g / dL vs. 12.0±2.46 g / dL，p <0.001），白蛋白与隐源组相比，（32.9±6.8g / L对比31.3±7.7g / L; p = 0.007）和凝血酶原时间（13.2±2.95s对比12.7±2.01s，p = 0.023）。隐源性HCC患者更常出现单灶性HCC（55.2％对46.5％; p = 0.002）。两组接受手术切除的患者比例无差异（HBV组为23.5％，隐源组为17.9％; p = 0.202）。 Cox回归分析显示隐源性相关HCC与HBV相关HCC之间无生存差异（p = 0.367）。
结论：

时间趋势表明，归因于HBV的HCC正在下降，而隐源性或NASH相关的HCC是新兴的临床实体。鉴于HCC流行病学不断变化的非病毒病因，可能需要对HCC的筛查，监测和管理方法进行范式转换。
关键词：

隐;乙型肝炎;肝细胞癌;新加坡

结论：
    30327962
DOI：
    10.1007 / s10620-018-5331-X