Temporal trends of nonalcoholic fatty liver disease-related hepatocellular carcinoma in the veteran affairs population.
Temporal trends of nonalcoholic fatty liver disease-related hepatocellular carcinoma in the veteran affairs population.
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DOI：
10.1016/j.cgh.2014.08.013
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发表时间：
2015-03
期刊：
影响因子：
--
通讯作者：
Davila JA
中科院分区：
文献类型：
--
作者：
Mittal S;Sada YH;El-Serag HB;Kanwal F;Duan Z;Temple S;May SB;Kramer JR;Richardson PA;Davila JA
非酒精性脂肪性肝病（NAFLD）是肝细胞癌（HCC）的危险因素。然而，美国没有系统的研究对nafld相关HCC的时间趋势、HCC监测实践和结果进行调查。我们确定了2005年至2010年在退伍军人管理局（VA）医院发生HCC的1500名患者的全国队列。我们查看了患者在退伍军人管理局的全部医疗记录；在没有丙型肝炎病毒（HCV）感染、乙型肝炎或酒精性肝病的情况下，根据代谢综合征的组织学证据或代谢综合征的存在来诊断NAFLD。我们比较了HCC患者中主要危险因素（NAFLD、酒精滥用、HCV）的年患病率，以及HCC监测和预后。120例（8.0%）患者中NAFLD是HCC的潜在危险因素；nafld相关HCC的年发生比例保持相对稳定（7.5%-12.0%）。相比之下，HCC合并HCV的比例从2005年的61.0%（95%可信区间，53.1%-68.9%）上升到2010年的74.9%（95%可信区间，69.0%-80.7%）。仅与酒精滥用相关的HCC病例比例从2005年的21.9%下降到2010年的15.7%，与乙型肝炎相关的HCC病例的年比例保持相对稳定（1.4%-3.5%）。nafld相关HCC患者发生肝硬化的比例（58.3%）明显低于酒精或hcv相关HCC患者（分别为72.4%和85.6%，P< 0.05）。与酒精或丙肝相关HCC患者相比，nafld相关HCC患者在确诊前3年内未接受HCC监测的比例明显更高。nafld相关HCC患者接受HCC特异性治疗的比例（61.5%）低于hcv相关HCC患者（77.5%，P< 0.01）。然而，不同危险因素相关的HCC患者的1年生存率没有差异。NAFLD是美国第三大HCC最常见的危险因素，2005 - 2010年NAFLD相关HCC的比例相对稳定。尽管nafld相关HCC患者接受较少的HCC监测和治疗，但与酒精或丙肝相关HCC患者相比，其存活1年的比例相似。
Non-alcoholic fatty liver disease (NAFLD) is a risk factor for hepatocellular carcinoma (HCC). However, no systemic studies from the United States have examined temporal trends, HCC surveillance practices, and outcomes of NAFLD-related HCC. We identified a national cohort of 1500 patients who developed HCC from 2005 through 2010 from Veterans Administration (VA) hospitals. We reviewed patients’ full VA medical records; NAFLD was diagnosed based on histologic evidence for, or the presence of, metabolic syndrome in the absence of hepatitis C virus (HCV) infection, hepatitis B, or alcoholic liver disease. We compared annual prevalence values for the main risk factors (NAFLD, alcohol abuse, HCV), as well HCC surveillance and outcomes, among HCC patients. NAFLD was the underlying risk factor for HCC in 120 patients (8.0%); the annual proportion of NAFLD-related HCC remained relatively stable (7.5%–12.0%). In contrast, the proportion of HCC cases associated with HCV increased from 61.0% in 2005 (95% confidence interval, 53.1%–68.9%) to 74.9% in 2010 (95% confidence interval, 69.0%–80.7%). The proportion of HCC cases associated with only alcohol abuse decreased from 21.9% in 2005 to 15.7% in 2010, and the annual proportion of HCC cases associated with hepatitis B remained relatively stable (1.4%–3.5%). A significantly lower proportion of patients with NAFLD-related HCC had cirrhosis (58.3%) compared to patients with alcohol- or HCV-related HCC (72.4% and 85.6%, respectively; P<.05). A significantly higher percentage of patients with NAFLD-related HCC did not receive HCC surveillance in the 3 years before their HCC diagnosis, compared to patients with alcohol- or HCV-associated HCC. A lower proportion of patients with NAFLD-related HCC received HCC-specific treatment (61.5%) than of patients with HCV-related HCC (77.5%; P<.01). However, 1-year survival did not differ among patients with HCC related to different risk factors. NAFLD is the third most common risk factor for HCC in the VA. The proportion of NAFLD-related HCC was relatively stable from 2005 through 2010. Although patients with NAFLD-related HCC receive less HCC surveillance and treatment, a similar proportion survive for 1 year, compared to patients with alcohol- or HCV-related HCC.
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影响因子：
9.8
作者：
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