Risk factors for survival and the development of hepatocellular carcinoma in patients with primary biliary cirrhosis.
Risk factors for survival and the development of hepatocellular carcinoma in patients with primary biliary cirrhosis.
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DOI：
10.2169/internalmedicine.52.0010
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发表时间：
2013
影响因子：
1.2
通讯作者：
Yasuyuki Tomiyama;K. Takenaka;T. Kodama;M. Kawanaka;Kyo Sasaki;S. Nishina;N. Yoshioka;Yuichi Hara;K. Hino
中科院分区：
文献类型：
--
作者：
Yasuyuki Tomiyama;K. Takenaka;T. Kodama;M. Kawanaka;Kyo Sasaki;S. Nishina;N. Yoshioka;Yuichi Hara;K. Hino
目的原发性胆汁性肝硬化（PBC）患者的预后得到改善，早期诊断肝癌（HCC）是治疗PBC的关键。本研究的目的是调查HCC的发展是否影响PBC的预后，并确定日本PBC患者HCC的危险因素。方法对210例中位随访8.5年的原发性肝细胞癌（PBC）患者的生存率进行比较，并分析HCC发生的危险因素。结果11例患者（5.2%）在随访期间发生HCC，5例患者（2.4%）在诊断PBC时同时被诊断，这些患者被排除在分析之外。Kaplan-Meier分析显示发生和未发生HCC的患者的总生存率有显著差异（p<0.001）。多变量分析显示年龄（OR：1.08，95%置信区间[CI]：1.03-1.13，p=0.001），白蛋白水平（OR：0.24，95%CI：0.10-0.56，p=0.001），总胆红素水平（OR：1.60，95%CI：1.09-2.36，p=0.017）和肝癌发展（OR：2.97，95%CI：1.24-7.15，p=0.015）是重要的预后因素，仅确定了晚期组织学分期（Scheuer分级III或IV，OR：6.27，95% CI：1.80-21.83，p=0.004）是HCC相关的危险因素。结论HCC的发生显著影响PBC患者的生存率，晚期组织学分期是HCC发生的唯一危险因素。这些结果强调了肝纤维化在PBC患者肝癌发生中的重要作用。
OBJECTIVE Early diagnosis of hepatocellular carcinoma (HCC) is critical in the management of patients with primary biliary cirrhosis (PBC), since the prognosis of PBC has improved. The aim of this study was to investigate whether HCC development affects the prognosis of PBC and to identify the risk factors for HCC in Japanese patients with PBC. METHODS We compared the survival rates between patients with HCC and those without and analyzed the risk factors for HCC development in 210 patients with PBC who were followed up for a median period of 8.5 years. RESULTS HCC developed during follow-up in 11 patients (5.2%) and was diagnosed simultaneously at the time of diagnosis of PBC in five patients (2.4%) who were excluded from the analysis. A Kaplan-Meier analysis showed a significant difference in overall survival between the patients who did and did not develop HCC (p<0.001). A multivariate analysis revealed age (OR: 1.08, 95% confidence interval [CI]: 1.03-1.13, p=0.001), the albumin level (OR: 0.24, 95% CI: 0.10-0.56, p=0.001), the total bilirubin level (OR: 1.60, 95% CI: 1.09-2.36, p=0.017) and HCC development (OR: 2.97, 95% CI: 1.24-7.15, p=0.015) to be significant prognostic factors and identified only an advanced histological stage (Scheuer's classification III or IV, OR: 6.27, 95% CI: 1.80-21.83, p=0.004) to be a risk factor associated with HCC. CONCLUSION HCC development significantly affects the survival of patients with PBC, and an advanced histological stage is the only risk factor associated with HCC development. These results highlight the important role of liver fibrosis in hepatocarcinogenesis in patients with PBC.