Risk factors for Fontan-associated hepatocellular carcinoma.
Risk factors for Fontan-associated hepatocellular carcinoma.
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DOI：
10.1371/journal.pone.0270230
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
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作者：
Fontan相关肝病患者中肝细胞癌（HCC）的发病率（即，随着时间的推移，HCC的发病率增加。然而，HCC发展的风险因素仍不清楚。在这里，我们比较了非侵袭性标志物的水平与HCC患者的生存率。从2003年到2021年，154名患者（66名男性，42.9%）在接受Fontan手术后发生了肝脏疾病。在15例（9.7%）（8例男性，53.3%）中诊断出HCC，中位年龄为34岁（范围，21-45岁）。我们比较了TPD-HCC和非HCC病例;我们使用受试者工作特征曲线生成标志物水平截止值。我们试图确定HCC和死亡率的危险因素。Fontan手术后20年内HCC的发生率为4.9%。与非肝癌患者相比，HCC患者多脾和食管静脉曲张的发生率更高。在HCC发展时，透明质酸（HA）水平（p = 0.04）和纤维化-4指数（p = 0.02）在HCC患者中显著高于非HCC患者;总胆红素（T-BIL）水平（p = 0.07）和终末期肝病模型评分[不包括国际标准化比率（MELD-XI）]（p = 0.06）在HD-HCC患者中倾向于更高。Fontan手术后约20年内，10名患者死亡（生存率，96.9%）。Kaplan-Meier曲线分析表明，T-BIL水平≥ 2.2 mg/dL，HA水平≥ 55.5 ng/mL，MELD-XI评分≥ 18.7的患者具有HCC的高风险，通常预后不良，以及多脾和食管静脉曲张。多因素考克斯回归分析显示多脾并发症[危险比（HR）：10.915]和较高的MELD-XI评分（HR：1.148，均p < 0.01）是HCC的独立危险因素。多脾并发症和MELD-XI评分可以预测HCC的发生和死亡率。
The incidence of hepatocellular carcinoma (HCC) in patients with Fontan-associated liver disease (i.e., FALD-HCC) has increased over time. However, the risk factors for HCC development remain unclear. Here, we compared the levels of non-invasive markers to the survival rate of FALD-HCC patients. From 2003 to 2021, 154 patients (66 men, 42.9%) developed liver disease after undergoing Fontan procedures. HCC was diagnosed in 15 (9.7%) (8 men, 53.3%) at a median age of 34 years (range, 21–45 years). We compared FALD-HCC and non-HCC cases; we generated marker level cutoffs using receiver operating characteristic curves. We sought to identify risk factors for HCC and mortality. The incidence of HCC was 4.9% in FALD patients within 20 years after the Fontan procedure. Compared with non-HCC patients, FALD-HCC patients exhibited higher incidences of polysplenia and esophageal varices. At the time of HCC development, the hyaluronic acid (HA) level (p = 0.04) and the fibrosis-4 index (p = 0.02) were significantly higher in FALD-HCC patients than in non-HCC patients; the total bilirubin (T-BIL) level (p = 0.07) and the model for end-stage liver disease score [excluding the international normalized ratio (MELD-XI)] (p = 0.06) tended to be higher in FALD-HCC patients. Within approximately 20 years of the Fontan procedure, 10 patients died (survival rate, 96.9%). Kaplan–Meier curve analysis indicated that patients with T-BIL levels ≥ 2.2 mg/dL, HA levels ≥ 55.5 ng/mL, and MELD-XI scores ≥ 18.7 were at high risk of HCC, a generally poor prognosis, and both polysplenia and esophageal varices. Multivariate Cox regression analyses indicated that the complication of polysplenia [Hazard ratio (HR): 10.915] and a higher MELD-XI score (HR: 1.148, both p < 0.01) were independent risk factors for FALD-HCC. The complication of polysplenia and a MELD-XI score may predict HCC development and mortality in FALD patients.
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影响因子：
3.7
作者：
Abe S;Yoshihisa A;Takiguchi M;Shimizu T;Nakamura Y;Yamauchi H;Iwaya S;Owada T;Miyata M;Sato T;Suzuki S;Oikawa M;Kobayashi A;Yamaki T;Sugimoto K;Kunii H;Nakazato K;Suzuki H;Saitoh S;Takeishi Y
通讯作者：
Takeishi Y
影响因子：
5.7
作者：
Kiesewetter, Christoph H.;Sheron, Nick;Veldtman, Gruschen R.
通讯作者：
Veldtman, Gruschen R.
影响因子：
2.8
作者：
Pundi, Krishna;Pundi, Kavitha N.;Johnson, Jonathan N.
通讯作者：
Johnson, Jonathan N.
影响因子：
3.7
作者：
Isoura Y;Yamamoto A;Cho Y;Ehara E;Jogo A;Suzuki T;Amano-Teranishi Y;Kioka K;Hamazaki T;Murakami Y;Tokuhara D
通讯作者：
Tokuhara D
DOI：
10.1016/j.cgh.2009.05.033
发表时间：
2009-10
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Shah AG;Lydecker A;Murray K;Tetri BN;Contos MJ;Sanyal AJ;Nash Clinical Research Network
通讯作者：
Nash Clinical Research Network