Risk factors for hepatocellular carcinoma in patients with chronic liver disease: a case-control study
Risk factors for hepatocellular carcinoma in patients with chronic liver disease: a case-control study
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DOI：
10.1007/s10552-012-9895-z
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发表时间：
2012-03-01
影响因子：
2.3
通讯作者：
Nguyen, Mindie H.
中科院分区：
文献类型：
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作者：
Ha, Nghi B.;Ha, Nghiem B.;Nguyen, Mindie H.
关于肝细胞癌（HCC）风险因素（RF）的大多数数据来自涉及无基础肝病人群的研究。在慢性肝病患者中评估HCC的RF非常重要，因为HCC很少发生在没有基础肝病的患者中。我们在2001年2月至2009年12月期间从斯坦福大学医学中心的肝脏诊所通过方便抽样对259例新发HCC病例和781例对照进行了一项以医院为基础的病例对照研究。研究人群为41%白色、14%西班牙裔、3%非裔美国人、40%亚裔美国人和2%其他人种/种族。通过医疗记录和面对面的问卷调查来检查RF。酒精和烟草的使用是通过一生中消耗的酒精的累积克数或香烟的累积包数计算的。糖尿病（DM）定义为随机血糖水平为千分之一日元200 mg/dL。使用多变量logistic回归评估RF。在相互调整和额外控制酒精使用、肝病病因和DM后，HCC风险的独立预测因素包括年龄> 40岁（OR = 8.5 [2.6-28.3]），男性（OR = 3.5 [2.2-5.8]），存在肝硬化（OR = 2.8 [1.6-4.9]），亚裔（OR = 2.8 [1.8-4.6]），AFP > 50（OR = 4.2 [2.6-6.8]），以及累积终生烟草使用> 11，000包（OR = 1.7 [1.0-2.9]）。长期大量吸烟，而不是饮酒，是有基础肝病患者发生HCC的重要独立预测因素。除了年龄较大，男性，肝硬化，AFP升高，亚洲种族和大量累积烟草使用是HCC的强独立预测因子。
The majority of data on risk factors (RFs) for hepatocellular carcinoma (HCC) comes from studies involving populations without underlying liver disease. It is important to evaluate RFs for HCC in patients with chronic liver disease since HCC rarely occurs in those without underlying liver disease. We conducted a hospital-based case-control study of 259 incident HCC cases and 781 controls by convenience sampling between 02/2001 and 12/2009 from the liver clinic at Stanford University Medical Center. The study population was 41% White, 14% Hispanic, 3% African American, 40% Asian American, and 2% other race/ethnicity. RFs were examined through medical records and an in-person questionnaire. Alcohol and tobacco use was calculated by cumulative grams of alcohol or cumulative pack(s) of cigarette consumed over one's lifetime. Diabetes mellitus (DM) was defined by random glucose level of a parts per thousand yen200 mg/dL. RFs were evaluated using multivariate logistic regression. Independent predictors of HCC risk, after mutual adjustment and additional control for alcohol use, etiology of liver diseases, and DM, included age > 40 (OR = 8.5 [2.6-28.3]), male gender (OR = 3.5 [2.2-5.8]), presence of cirrhosis (OR = 2.8 [1.6-4.9]), Asian ethnicity (OR = 2.8 [1.8-4.6]), AFP > 50 (OR = 4.2 [2.6-6.8]), and cumulative lifetime tobacco use of > 11,000 packs (OR = 1.7 [1.0-2.9]). Heavy prolonged cigarette smoking, but not alcohol use, was a significant independent predictor for HCC in patients with underlying liver disease. Besides older age, male gender, presence of cirrhosis, and elevated AFP, Asian ethnicity and heavy cumulative tobacco use are strong independent predictors of HCC.