丙型肝炎相关的晚期肝脏患者中肝癌的发病率

liver411

及相关危险因素
Incidence of hepatocellular carcinoma and associated risk factors in hepatitis C-related advanced liver disease.
丙型肝炎相关的晚期肝脏患者中肝癌的发病率及相关危险因素
出处：Gastroenterology   2009  Jan  136(1) :138-48
作者：Lok AS;Seeff LB;Morgan TR;di Bisceglie AM;Sterling RK;Curto TM;Everson GT;Lindsay KL;Lee WM;Bonkovsky HL;Dienstag JL;Ghany MG;Morishima C;Goodman ZD
PMID：18848939

BACKGROUND & AIMS: Although the incidence of hepatocellular carcinoma (HCC) is increasing in the United States, data from large prospective studies are limited. We evaluated the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) cohort for the incidence of HCC and associated risk factors. METHODS: Hepatitis C virus-positive patients with bridging fibrosis or cirrhosis who did not respond to peginterferon and ribavirin were randomized to groups that were given maintenance peginterferon for 3.5 years or no treatment. HCC incidence was determined by Kaplan-Meier analysis, and baseline factors associated with HCC were analyzed by Cox regression. RESULTS: 1,005 patients (mean age, 50.2 years; 71% male; 72% white race) were studied; 59% had bridging fibrosis, and 41% had cirrhosis. During a median follow-up of 4.6 years (maximum, 6.7 years), HCC developed in 48 patients (4.8%). The cumulative 5-year HCC incidence was similar for peginterferon-treated patients and controls, 5.4% vs 5.0%, respectively (P= .78), and was higher among patients with cirrhosis than those with bridging fibrosis, 7.0% vs 4.1%, respectively (P= .08). HCC developed in 8 (17%) patients whose serial biopsy specimens showed only fibrosis. A multivariate analysis model comprising older age, black race, lower platelet count, higher alkaline phosphatase, esophageal varices, and smoking was developed to predict the risk of HCC. CONCLUSIONS: We found that maintenance peginterferon did not reduce the incidence of HCC in the HALT-C cohort. Baseline clinical and laboratory features predicted risk for HCC. Additional studies are required to confirm our finding of HCC in patients with chronic hepatitis C and bridging fibrosis.

背景与目的：虽然美国肝细胞癌（HCC）的发病率呈现增加，但大型前瞻性研究的数据尚十分有限。我们评估了丙型肝炎抗肝硬化抗病毒长期治疗（HALT-C）研究中的一个队列，分析HCC的发病率及相关危险因素。方法：对聚乙二醇化干扰素和利巴韦林治疗无应答的桥接纤维化或肝硬化的丙型肝炎病毒阳性患者，随机分组，给予聚乙二醇化干扰素治疗3.5年或者不接受任何治疗。使用Kaplan-Meier分析测定肝癌发病率，Cox回归分析与HCC相关的基线因素。结果：研究了1005名（平均年龄， 50.2岁; 71 ％是男性; 72 ％白色人种）患者; 59 ％有桥接纤维化， 41 ％为肝硬化。在平均随访4.6年期间（最长，6.7年），48名患者发生肝癌（4.8 ％）。聚乙二醇化干扰素治疗的患者和对照组的5年累计HCC发病率相似， 分别为5.4 ％和5.0 ％（P均= 0.78），并于较高肝硬化患者比那些桥接纤维化， 7.0 ％和4.1 ％（ P均= 0.08）。连续活检样本显示仅有纤维化的患者，有8例发生肝癌（17 ％）。建立包含有年龄、黑色人种、血小板计数降低、碱性磷酸酶升高、食管静脉曲张和吸烟的多变量分析模型，用于预测肝癌的风险。结论：我们发现，在 HALT-C队列中，聚乙二醇化干扰素维持治疗并不降低肝癌的发病率。基线的临床及实验室特征可预测肝癌的风险。需要进一步的研究来确认我们所发现的慢性丙型肝炎和桥接纤维化患者HCC的发生情况。

专家评价：
Richard Sampliner
University of Arizona, United States of America
Gastroenterology & Hepatology
Changes Clinical Practice: Peginterferon should not be used chronically with an expectation of decreasing the incidence of hepatocellular carcinoma (HCC).
Maintenance peginterferon did not reduce HCC in this randomized trial of over a thousand hepatitis C virus (HCV) patients. The incidence of HCC was 1% per year over a median follow-up of 4.6 years.
Prior to this study, mostly non-randomized trials suggested that interferon therapy reduced the development of HCC in HCV patients. This 1005-patient randomized trial failed to find a treatment effect. Ten clinical centers contributed patients who had failed to achieve a sustained viral response after interferon therapy with or without ribavirin. Advanced fibrosis, hepatic decompensation and HCC were exclusion criteria. Including all patients, the incidence of HCC was 4.8% over a median follow-up of 4.6 years.

风雨蔷薇

Liver411医生，这么早就开始工作了! 您要多保重身体哟!