Dysplastic nodules frequently develop into hepatocellular carcinoma in patients with chronic viral hepatitis and cirrhosis
Dysplastic nodules frequently develop into hepatocellular carcinoma in patients with chronic viral hepatitis and cirrhosis
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DOI：
10.1002/cncr.21607
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发表时间：
2006-02-01
期刊：
影响因子：
6.2
通讯作者：
Kumada, H
中科院分区：
文献类型：
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作者：
Kobayashi, M;Ikeda, K;Kumada, H
背景影像学技术的进步提高了慢性肝病过程中小结节病变的检出率。在1995年至2002年期间，作者连续检查了154例无肝细胞癌（HCC）的肝小结节患者，平均持续时间为2.8年。这些结节的中位尺寸为14 mm（范围，7-40 mm）。初步组织病理学诊断包括高度异型增生结节（HGDN）（n = 13）、低度异型增生结节（LGDN）（n = 42）和再生结节（RN）（n = 99）。在观察期间，共有29个（18.8%）结节发展为HCC。HGDN组第1年、第3年和第5年的累积HCC发生率分别为46.2%、61.5%和80.8%; LGDN组分别为2.6%、30.2%和36.6%; RN组分别为3.3%、9.7%和12.4%。HGDN组肝癌发生率明显高于其他类型（P < 0.001）。多因素分析显示，组织病理学诊断（P < 0.001）和CT动脉门静脉造影（CT AP）结果（P = 0.004）与未来HCC的发展显著相关。HGDN和LGDN的风险比分别为16.8（95%置信区间[CI]，6.19-45.6）和2.96（95% CI，1.20-7.31）。门静脉血流量减少的风险比也显著较高，为3.04（95% CI，1.42-6.50）。HGDN患者发展为HCC的年发生率约为20%，而LGDN患者为10%。在慢性病毒性肝炎或肝硬化的随访中出现HGDN应考虑为癌前病变。CT-AP上结节内门静脉血流量减少也是肝细胞癌发展的重要预测因素。
BACKGROUND. Advances in imaging technology have enhanced the detection of small nodular lesions during the course of chronic liver disease.METHODS. Between 1995 and 2002, the authors examined 154 consecutive patients with small hepatic nodules without hepatocellular carcinoma (HCC) over a median duration of 2.8 years. The median size of these nodules was 14 mm (range, 7-40 mm). The initial histopathologic diagnosis included high-grade dysplastic nodule (HGDN) (n = 13), low-grade dysplastic nodule (LGDN) (n = 42), and regenerative nodule (RN) (n = 99).RESULTS. A total of 29 (18.8%) nodules developed into HCC during the observation period. Cumulative HCC development rates at the first, third, and fifth year were 46.2%, 61.5%, and 80.8% for HGDN; 2.6%, 30.2%, and 36.6% for LGDN; and 3.3%, 9.7%, and 12.4% for RN, respectively. The rate of HCC development was significantly higher in the HGDN group than for other types (P < 0.001). Multivariate analysis disclosed that histopathologic diagnosis (P < 0.001) and findings on computed tomographic arterial portography (CT-AP) (P = 0.004) were significantly associated with future HCC development. The hazard ratios of HGDN and LGDN were 16.8 (95% confidence interval [CI], 6.19-45.6) and 2.96 (95% Cl, 1.20-7.31), respectively. A decrease in portal blood flow also showed a significantly high hazard ratio of 3.04 (95% Cl, 1.42-6.50). Approximate annual development rate to HCC was 20% in patients with HGDN and 10% in LGDN.CONCLUSION. HGDN should be considered a precancerous lesion when it appears during follow-up of chronic viral hepatitis or cirrhosis. Reduced portal blood flow in the nodule on computed tomography-AP is also an important predictor for development of hepatocellular carcinoma.