Risk of hepatocellular carcinoma in Danish outpatients with alcohol-related cirrhosis
Risk of hepatocellular carcinoma in Danish outpatients with alcohol-related cirrhosis
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DOI：
10.1016/j.jhep.2020.05.043
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发表时间：
2020-11-01
影响因子：
25.7
通讯作者：
Vilstrup, Hendrik
中科院分区：
文献类型：
--
作者：
Jepsen, Peter;Kraglund, Frederik;Vilstrup, Hendrik
背景和目标：准确估计肝硬化患者发生肝细胞癌（HCC）的风险对于指导监测策略非常重要。我们描述了酒精相关性肝硬化门诊患者的HCC风险，并将HCC死亡风险与静脉曲张出血或创伤死亡风险进行了对比。方法：这是一项2006年至2018年的全国性基于登记的历史队列研究。我们纳入了所有丹麦门诊患者，医院诊断为酒精相关性肝硬化，除了癌症，慢性病毒性肝炎或自身免疫性肝病，以及80岁以上。我们对他们进行了2018年的随访，并描述了HCC的累积风险以及HCC、静脉曲张出血或创伤的累积死亡风险。结果：在纳入的4,553例患者中，181例发生HCC，2,274例死亡。1年后HCC的累积风险为0.9%（95% CI 0.7-1.3），5年后为3.6%（95% CI 3.0-4.2），10年后为6.0%（95% CI 5.1-7.0），或每年约为0.7%。男性、年龄较大、失代偿性肝硬化预示着较高的肝癌风险。10年后，队列中6.9%的死亡可归因于HCC，而6.5%可归因于静脉曲张出血，5.0%可归因于traumature.Conclusions：在2006-2018年，丹麦酒精相关肝硬化门诊患者每年HCC的风险为0.7%，他们死于静脉曲张出血或外伤的可能性与HCC几乎相同。这意味着，许多潜在的有害的检查，需要通过监测发现的每一个肝细胞癌，所以针对其他原因的预防干预措施可能是更具成本效益的summary：我们描述了丹麦门诊肝硬化患者肝细胞癌（肝细胞癌，最常见的肝癌起源于肝脏）的风险，由于有害的酒精消费。关于这种风险的准确数据对于患者咨询和关于筛查HCC的决定非常重要。每年的风险约为0.7%，低于预期，这表明通过监测发现的每个HCC都需要进行许多潜在有害的筛查检查。(C)2020年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background and Aims: Accurate estimates of hepatocellular carcinoma (HCC) risk in patients with cirrhosis are important to guide surveillance strategies. We described HCC risk among outpatients with alcohol-related cirrhosis and contrasted the risk of death from HCC with the risk of death from variceal bleeding or trauma.Methods: This was a nationwide, registry-based historical cohort study between 2006 and 2018. We included all Danish outpatients with a hospital diagnosis of alcohol-related cirrhosis, except those with cancer, those with chronic viral hepatitis or autoimmune liver disease, and those older than 80 years. We followed them through 2018 and described the cumulative risk of HCC and the cumulative risk of death from HCC, variceal bleeding, or trauma.Results: Of the 4,553 patients included, 181 developed HCC and 2,274 died. The cumulative risk of HCC was 0.9% (95% CI 0.7-1.3) after 1 year, 3.6% (95% CI 3.0-4.2) after 5 years, and 6.0% (95% CI 5.1-7.0) after 10 years, or approximately 0.7% per year. Male sex, older age, and decompensated cirrhosis predicted a higher HCC risk. After 10 years, 6.9% of deaths in the cohort could be attributed to HCC, whereas 6.5% could be attributed to variceal bleeding, and 5.0% to trauma.Conclusions: In 2006-2018, Danish outpatients with alcoholrelated cirrhosis had an HCC risk of 0.7% per year, and they were nearly as likely to die from variceal bleeding or from trauma as from HCC. The implications are that many potentially harmful examinations are required for every HCC found through surveillance, so interventions targeting the prevention of other causes of death might be more cost-effective.Lay summary: We described the risk of hepatocellular carcinoma (HCC, the most common form of liver cancer originating in the liver) in Danish outpatients with cirrhosis due to harmful alcohol consumption. Accurate data on that risk are important for patient counselling and decisions about screening for HCC. The risk was about 0.7% per year, which is lower than might be expected and suggests that many potentially harmful screening examinations are required for every HCC found through surveillance. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.