Risk of Hepatocellular Cancer in Patients With Non-Alcoholic Fatty Liver Disease.
Risk of Hepatocellular Cancer in Patients With Non-Alcoholic Fatty Liver Disease.
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DOI：
10.1053/j.gastro.2018.08.024
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发表时间：
2018-12
期刊：
影响因子：
29.4
通讯作者：
El-Serag HB
中科院分区：
文献类型：
--
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
关于非酒精性脂肪性肝病(NAFLD)患者患肝细胞癌(HCC)风险的数据有限。我们的目的是评估NAFLD患者发生肝细胞癌的风险。我们对退伍军人健康管理局的130个机构进行了一项回溯性队列研究。纳入2004年1月1日至2008年12月31日期间诊断为NAFLD的患者，并对其进行跟踪调查，直至确诊为肝细胞癌、死亡或2015年12月31日。我们还确定了没有NAFLD的性别和年龄匹配的对照队列。我们从中央癌症登记中心和手动图表审查中确定了所有新的肝细胞癌病例。我们根据NAFLD状态以及NAFLD患者的亚组计算了肝细胞癌的发病率。我们使用相互竞争的风险模型来比较NAFLD患者和非NAFLD患者发生肝细胞癌的风险。我们回顾了所有发生在非酒精性脂肪肝患者中的肝细胞癌病例的电子病历。我们比较了296,707名NAFLD患者和296,707名匹配的对照组。在2382,289人年的随访中，490名NAFLD患者发展为肝细胞癌(0.21/1000人年)。NAFLD患者的肝癌发病率显著高于对照组(0.02/1000Py；危险比7.62，95%可信区间=5.76-10.09)。在NAFLD患者中，有肝硬化者的肝癌年发病率最高(10.6/1000PY)。在NAFLD肝硬变患者中，根据其他人口统计学特征，肝癌风险在每1000人年1.6至23.7之间；在患有肝硬变的西班牙裔老年患者中，患肝癌的风险最高。在病历回顾中，20%的非酒精性脂肪肝合并肝细胞癌患者没有肝硬变的证据。NAFLD患者发生肝细胞癌的风险高于一般临床人群。NAFLD中的肝细胞癌多发生于肝硬变患者。在大多数NAFLD肝硬变患者中，肝细胞癌的绝对风险高于接受的肝细胞癌监测阈值。
There are limited data on the risk of hepatocellular cancer (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). We aimed to estimate the risk of incident HCC among patients with NAFLD. We conducted a retrospective cohort study from a total of 130 facilities in the Veterans Health Administration. Patients with NAFLD diagnosed between 1/1/2004 and 12/31/2008 were included and followed until HCC diagnosis, death or 12/31/2015. We also identified a gender and age-matched control cohort without NAFLD. We ascertained all new HCC cases from the Central Cancer Registry and manual chart reviews. We calculated incidence rates for HCC by NAFLD status as well as in subgroups of NAFLD patients. We used competing risk models to compare the risk of HCC in patients with vs. those without NAFLD. We reviewed electronic medical records of all HCC cases that developed in NAFLD patients without cirrhosis. We compared 296,707 NAFLD patients with 296,707 matched controls. During 2,382,289 person-years [PY] of follow-up, 490 NAFLD patients developed HCC (0.21/1000 PY). HCC incidence was significantly higher among NAFLD patients vs. controls (0.02/1000 PY; hazard ratio, 7.62, 95% confidence interval=5.76–10.09). Among patients with NAFLD, those with cirrhosis had the highest annual incidence of HCC (10.6 /1000 PY). Among patients with NAFLD cirrhosis, HCC risk ranged from 1.6 to 23.7 per 1000 PY based on other demographic characteristics; the risk of HCC was the highest in older Hispanics with cirrhosis. In medical record reviews, 20% of NAFLD patients with HCC had no evidence of cirrhosis. Risk of HCC was higher in NAFLD patients than that observed in general clinical population. Most HCC cases in NAFLD developed in patients with cirrhosis. The absolute risk of HCC was higher than the accepted thresholds for HCC surveillance for most patients with NAFLD cirrhosis.
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DOI：
10.1016/j.cgh.2014.08.013
发表时间：
2015-03
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Mittal S;Sada YH;El-Serag HB;Kanwal F;Duan Z;Temple S;May SB;Kramer JR;Richardson PA;Davila JA
通讯作者：
Davila JA
影响因子：
3.3
作者：
Sohn MW;Arnold N;Maynard C;Hynes DM
通讯作者：
Hynes DM
1975年至2012年，向国家报告癌症状况的年度报告，其发病率不断增加。
影响因子：
6.2
作者：
Ryerson AB;Eheman CR;Altekruse SF;Ward JW;Jemal A;Sherman RL;Henley SJ;Holtzman D;Lake A;Noone AM;Anderson RN;Ma J;Ly KN;Cronin KA;Penberthy L;Kohler BA
通讯作者：
Kohler BA
DOI：
10.1016/j.cgh.2009.05.033
发表时间：
2009-10
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Shah AG;Lydecker A;Murray K;Tetri BN;Contos MJ;Sanyal AJ;Nash Clinical Research Network
通讯作者：
Nash Clinical Research Network
影响因子：
29.4
作者：
Chalasani, Naga;Younossi, Zobair;Sanyal, Arun J.
通讯作者：
Sanyal, Arun J.