Extrahepatic Malignancies in Nonalcoholic Fatty Liver Disease.
Extrahepatic Malignancies in Nonalcoholic Fatty Liver Disease.
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DOI：
10.1007/s11901-019-00499-5
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发表时间：
2019-12
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脂肪肝是非酒精性脂肪性肝病（NAFLD）患者的第二大常见死因。了解NAFLD中肝细胞癌以外的恶性肿瘤风险的独特特征对该高危人群的咨询和个性化预防措施具有重要意义。在此，我们系统地回顾了NAFLD中肝外恶性肿瘤的文献报道，并讨论了支撑过度肥胖和癌症风险之间关联的关键生物学机制。一些研究表明NAFLD和肝外恶性肿瘤之间存在显著相关性。最强的关联被发现与胃肠道癌症和胃肠道敏感性癌症。最近的数据支持NAFLD中癌症风险增加的性别特异性差异：男性结直肠癌和女性子宫癌。NAFLD中癌症发展的风险高于单纯肥胖。在过去的十年中，越来越多的观察证据支持NAFLD和肝外恶性肿瘤之间的关联。这种关联需要进一步的研究，理想的设计是在特征良好的大型NAFLD患者队列中包括BMI以外的更详细的体脂沉积测量，以确定是否应在该组中个性化筛查政策。
Malignancy is the second most common cause of death in individuals with nonalcoholic fatty liver disease (NAFLD). Understanding unique characteristics of malignancy risk beyond hepatocellular carcinoma in NAFLD has significant implications in counseling and personalized preventative measures in this high-risk population. Herein, we systematically review the literature reporting extra-hepatic malignancies in NAFLD and discuss the key biological mechanisms underpinning the association between excess adiposity and cancer risk. Several studies have shown significant associations between NAFLD and extrahepatic malignancies. The strongest association was found with cancers of the gastrointestinal tract and hormone-sensitive cancers. Recent data support sex-specific differences in cancer risk increase in NAFLD: colorectal cancer in men and uterine cancer in women. The risk of cancer development is higher in NAFLD than obesity alone. A growing body of observational evidence over the last decade supports the association between NAFLD and extrahepatic malignancies. This association requires further studies, ideally designed to include more detailed measures of body fat deposition beyond BMI in well-characterized, large cohorts of NAFLD patients, to determine if screening policies should be individualized in this group.