Multicenter, retrospective, cohort study shows platelet counts predict hepatocellular carcinoma development in patients with nonalcoholic fatty liver disease
Multicenter, retrospective, cohort study shows platelet counts predict hepatocellular carcinoma development in patients with nonalcoholic fatty liver disease
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DOI：
10.1111/hepr.13884
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发表时间：
2023-02-17
影响因子：
4.2
通讯作者：
Okanoue, Takeshi
中科院分区：
文献类型：
--
作者：
Fujii, Hideki;Fujii, Makoto;Okanoue, Takeshi
目的 肝活检时血小板计数对非酒精性脂肪性肝病 (NAFLD) 患者肝细胞癌 (HCC) 发展的影响仍不清楚。本研究的目的是利用多中心研究的数据探讨血小板计数对活检确诊的 NAFLD 患者的预后价值。方法 亚洲 CLIONE（非酒精性脂肪肝临床结果）研究的亚组分析纳入了 1,398 名患者。使用NASH临床研究网络系统对肝活检标本进行病理学诊断和组织学评分。收集人口统计、临床、实验室和病理数据。结果在 4.6 年（范围：0.3-21.6 年）的中位随访期间（相当于 8874 人年），37 名患者发展为 HCC。使用 192 x 109/L 的截止基线血小板计数，较低血小板组的 HCC 发生率高于较高血小板组（6.7% vs. 0.4%；p < 0.001）。该临界值对 HCC 的无事件率进行了显着分层。血小板计数较低与肝癌发生风险增加相关。相对于血小板计数为 192 x 109/L 的患者，血小板计数为 100 x 109/L 的患者发生 HCC 的未经调整的风险比 (HR) 为 7.37（95% 置信区间 [CI], 3.81-14.2），调整后的 HR 为 11.2（95% CI, 3.81-32.7；p < 0.001）。年龄、性别、NASH 和 糖尿病。结论 基线血小板计数 192 x 109/L 及更低与活检确诊的 NAFLD 患者发生 HCC 的风险较高相关，需要积极监测。
AimImpacts of platelet counts at the time of liver biopsy on hepatocellular carcinoma (HCC) development in patients with nonalcoholic fatty liver disease (NAFLD) remain unknown. The aim of this study was to investigate the prognostic value of platelet counts in patients with biopsy-confirmed NAFLD using data from a multicenter study. MethodsOne thousand three hundred ninety-eight patients were included in this subanalysis of the CLIONE (Clinical Outcome Nonalcoholic Fatty Liver Disease) in Asia study. Liver biopsy specimens were pathologically diagnosed, and histologically scored using the NASH Clinical Research Network system. Demographic, clinical, laboratory, and pathological data were collected. ResultsDuring a median follow-up period of 4.6 years (range, 0.3-21.6 years), which corresponds to 8874 person-years, 37 patients developed HCC. Using a cut-off baseline platelet count of 192 x 109/L, the lower platelet group had a higher HCC rate than the higher platelet group (6.7% vs. 0.4%; p < 0.001). This cut-off value significantly stratified the event-free rate for HCC. Lower platelet counts were associated with an increased risk of HCC development. Relative to patients with platelet counts of 192 x 109/L, patients with platelet counts of 100 x 109/L had an unadjusted hazard ratio (HR) for HCC development of 7.37 (95% confidence interval [CI], 3.81-14.2) and an adjusted HR of 11.2 (95% CI, 3.81-32.7; p < 0.001), adjusting for age, sex, NASH, and diabetes. ConclusionsBaseline platelet counts of 192 x 109/L and lower are associated with a higher risk of developing HCC in patients with biopsy-confirmed NAFLD and require active surveillance.