Cancer Risk in Patients With Biopsy-Confirmed Nonalcoholic Fatty Liver Disease: A Population-Based Cohort Study.
Cancer Risk in Patients With Biopsy-Confirmed Nonalcoholic Fatty Liver Disease: A Population-Based Cohort Study.
复制标题
DOI：
10.1002/hep.31845
复制
发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
最近的研究将非酒精性脂肪性肝病（NAFLD）与肝细胞癌（HCC）和肝外癌的发病率增加联系起来。然而，先前的研究规模较小或缺乏肝脏组织学，这仍然是NAFLD严重程度分期的金标准。我们对1966年至2016年瑞典所有组织学定义为NAFLD的成年人进行了一项基于人群的队列研究（N=8,892）。NAFLD是根据提交给瑞典所有28个病理部门的前瞻性肝脏组织病理学记录来定义的，分为单纯性脂肪变性、非纤维化性非酒精性脂肪性肝炎（NASH）、非肝硬化纤维化和肝硬化。NAFLD患者按年龄、性别、日历年和县分别与≤5名无NAFLD的普通人群对照（N=39,907）配对。使用Cox比例风险模型，我们计算了多变量调整风险比（aHRs）和95%置信区间（CIs）。在平均13.8年的时间里，我们记录了1,691例NAFLD患者和6,733例对照组的癌症事件。与对照组相比，NAFLD患者总体癌症发病率显著增加（10.9 vs. 13.8/ 1000人年[PYs]；差异=2.9/ 1000人年；aHR, 1.27 [95%CI, 1.18-1.36]），主要由HCC驱动（差异=1.1/ 1000人年；aHR, 17.08 [95%CI, 11.56-25.25]）。HCC发病率在单纯性脂肪变性、非纤维化性NASH、非肝硬化纤维化和肝硬化类别中单调增加（分别为0.8/1,000 PYs、1.2/1,000 PYs、2.3/1,000 PYs和6.2/1,000 PYs） （p趋势<0.01），并被糖尿病进一步放大（分别为1.2/1,000 PYs、2.9/1,000 PYs、7.2/1,000 PYs和15.7/1,000 PYs）。相比之下，NAFLD与胰腺癌、肾癌/膀胱癌和黑色素瘤的发生率适度增加相关（差异分别为0.2/ 1000 PYs、0.1/ 1000 PYs和0.2/ 1000 PYs），但与其他癌症无关。与对照组相比，活检证实的NAFLD患者的癌症发病率显著增加，主要是由于HCC，而肝外癌的贡献不大。虽然肝硬化患者发生HCC的风险最高，但非肝硬化纤维化和合并症糖尿病患者发生HCC的风险也相当高。
Recent studies link nonalcoholic fatty liver disease (NAFLD) to an increased incidence of hepatocellular carcinoma (HCC) and extrahepatic cancers. However, prior studies were small or lacked liver histology, which remains the gold standard for staging NAFLD severity. We conducted a population-based cohort study of all adults with histologically defined NAFLD in Sweden from 1966 to 2016 (N=8,892). NAFLD was defined from prospectively recorded liver histopathology submitted to all 28 Swedish pathology departments and categorized as simple steatosis, nonfibrotic nonalcoholic steatohepatitis (NASH), noncirrhotic fibrosis, and cirrhosis. NAFLD patients were individually matched to ≤5 general population controls without NAFLD by age, sex, calendar year, and county (N=39,907). Using Cox proportional hazards modeling, we calculated multivariable adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Over a median of 13.8 years, we documented 1,691 incident cancers among NAFLD patients and 6,733 among controls. Compared with controls, NAFLD patients had significantly increased overall cancer incidence (10.9 vs. 13.8/1,000 person-years [PYs]; difference=2.9/1,000 PYs; aHR, 1.27 [95%CI, 1.18–1.36]), driven primarily by HCC (difference=1.1/1,000 PYs; aHR, 17.08 [95%CI, 11.56–25.25]). HCC incidence rates increased monotonically across categories of simple steatosis, nonfibrotic NASH, noncirrhotic fibrosis, and cirrhosis (0.8/1,000 PYs, 1.2/1,000 PYs, 2.3/1,000 PYs, and 6.2/1,000 PYs, respectively) (Ptrend<0.01) and were further amplified by diabetes (1.2/1,000 PYs, 2.9/1,000 PYs, 7.2/1,000 PYs, and 15.7/1,000 PYs, respectively). In contrast, NAFLD was associated with modestly increased rates of pancreatic cancer, kidney/bladder cancer, and melanoma (differences=0.2/1,000 PYs, 0.1/1,000 PYs, and 0.2/1,000 PYs, respectively) but no other cancers. Compared with controls, patients with biopsy-proven NAFLD had significantly increased cancer incidence, due primarily to HCC, whereas the contribution of extrahepatic cancers was modest. Although HCC risk was highest with cirrhosis, substantial excess risk was also found with noncirrhotic fibrosis and comorbid diabetes.
登录
查看更多内容
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：
16.2
作者：
Esposito K;Chiodini P;Colao A;Lenzi A;Giugliano D
通讯作者：
Giugliano D
影响因子：
24.5
作者：
Hagstrom, Hannes;Thiele, Maja;Ludvigsson, Jonas F.
通讯作者：
Ludvigsson, Jonas F.
影响因子：
50.5
作者：
Malvezzi, M.;Carioli, G.;Negri, E.
通讯作者：
Negri, E.
影响因子：
13.8
作者：
Kleiner, David E.;Brunt, Elizabeth M.;Yates, Katherine P.
通讯作者：
Yates, Katherine P.