Effects of Cirrhosis and Diagnosis Scenario in Metabolic-Associated Fatty Liver Disease-Related Hepatocellular Carcinoma.
Effects of Cirrhosis and Diagnosis Scenario in Metabolic-Associated Fatty Liver Disease-Related Hepatocellular Carcinoma.
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DOI：
10.1002/hep4.1606
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发表时间：
2021-01
影响因子：
5.1
通讯作者：
Nguyen MH
中科院分区：
文献类型：
--
作者：
Chen VL;Yeh ML;Yang JD;Leong J;Huang DQ;Toyoda H;Chen YL;Guy J;Maeda M;Tsai PC;Huang CF;Yasuda S;Le AK;Dang H;Giama NH;Ali HA;Zhang N;Wang X;Jun DW;Tseng CH;Hsu YC;Huang JF;Dai CY;Chuang WL;Zhu Q;Dan YY;Schwartz M;Roberts LR;Yu ML;Nguyen MH
我们对代谢功能障碍相关肝细胞癌进行了一项多中心回顾性队列研究。在这个队列中，肝硬化与较差的生存率无关，而肝脏影像学史与之相关。 代谢相关性脂肪肝（MAFLD）是肝脏相关并发症的主要原因，包括肝细胞癌（HCC）。虽然已知MAFLD相关HCC发生在没有肝硬化的情况下，但我们对这种情况下MAFLD相关HCC的了解有限。在这里，我们描述了MAFLD相关的HCC以及肝硬化和筛查对生存率的影响。这是一项MAFLD相关HCC的多中心、回顾性、队列研究。MAFLD的定义是基于存在种族调整的超重、糖尿病或高血压和血脂异常，而不存在过量饮酒或其他肝病的潜在原因。主要关注的结果是总生存率，主要因变量是肝硬化状态和既往HCC筛查。我们使用Kaplan-Meier方法估计总生存期，使用考克斯比例风险模型和随机森林机器学习来确定与预后相关的因素。该研究纳入了来自美国和东亚/东南亚11个中心的1，382例患者。62%的患者存在肝硬化，但这些患者中有不到一半在HCC诊断后12个月内进行了成像。肝硬化患者更有可能患有早期疾病，但接受治愈治疗的频率较低。校正后，肝硬化与预后无关，但诊断时存在癌症相关症状与预后较差相关。结论：在MAFLD相关HCC队列中，肝硬化与总生存率无关，而在存在症状的情况下诊断与预后较差相关。在多中心队列中，MAFLD相关HCC患者的HCC监测率非常低。
We conducted a multicenter retrospective cohort study of metabolic dysfunction‐associated hepatocellular carcinoma. In this cohort, cirrhosis was not associated with poorer survival, while history of liver imaging was. Metabolic‐associated fatty liver disease (MAFLD) is a major cause of liver‐related complications, including hepatocellular carcinoma (HCC). While MAFLD‐related HCC is known to occur in the absence of cirrhosis, our understanding of MAFLD‐related HCC in this setting is limited. Here, we characterize MAFLD‐related HCC and the impact of cirrhosis and screening on survival. This was a multicenter, retrospective, cohort study of MAFLD‐related HCC. MAFLD was defined based on the presence of race‐adjusted overweight, diabetes, or both hypertension and dyslipidemia in the absence of excess alcohol use or other underlying cause of liver disease. The primary outcome of interest was overall survival, and the primary dependent variables were cirrhosis status and prior HCC screening. We used Kaplan‐Meier methods to estimate overall survival and Cox proportional hazards models and random forest machine learning to determine factors associated with prognosis. This study included 1,382 patients from 11 centers in the United States and East/Southeast Asia. Cirrhosis was present in 62% of patients, but under half of these patients had undergone imaging within 12 months of HCC diagnosis. Patients with cirrhosis were more likely to have early stage disease but less often received curative therapy. After adjustment, cirrhosis was not associated with prognosis, but the presence of cancer‐related symptoms at diagnosis was associated with poorer prognosis. Conclusion: Cirrhosis was not associated with overall survival in this cohort of MAFLD‐related HCC, while diagnosis in the presence of symptoms was associated with poorer prognosis. The HCC surveillance rate in patients with MAFLD‐related HCC was disappointingly low in a multicenter cohort.
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影响因子：
29.4
作者：
Kanwal F;Kramer JR;Mapakshi S;Natarajan Y;Chayanupatkul M;Richardson PA;Li L;Desiderio R;Thrift AP;Asch SM;Chu J;El-Serag HB
通讯作者：
El-Serag HB
影响因子：
13.5
作者：
Atiq, Omair;Tiro, Jasmin;Singal, Amit G.
通讯作者：
Singal, Amit G.
影响因子：
29.4
作者：
Loomba R;Lim JK;Patton H;El-Serag HB
通讯作者：
El-Serag HB
影响因子：
4.5
作者：
Burza, Maria Antonella;Pirazzi, Carlo;Romeo, Stefano
通讯作者：
Romeo, Stefano
影响因子：
12.6
作者：
Choi, Debra T.;Kum, Hye-Chung;Singal, Amit G.
通讯作者：
Singal, Amit G.