Hepatocellular carcinoma in the non-cirrhotic liver
Hepatocellular carcinoma in the non-cirrhotic liver
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DOI：
10.1007/s00292-007-0953-3
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发表时间：
2008-02-01
期刊：
影响因子：
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通讯作者：
Dombrowski, F.
中科院分区：
文献类型：
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作者：
Evert, M.;Dombrowski, F.
在肝细胞癌中，15%-20%发生在非肝硬变的肝脏。当出现肝硬变(LC)时，所有导致肝癌的因素也可以导致没有LC的肝癌。根据其相对发病频率，可大致分为3组：1)肝细胞癌，极少无肝硬变(如病毒性肝炎、酗酒)。2)多发于无LC的肝细胞癌(α1-抗胰蛋白酶缺乏症、血色素沉着症、非酒精性脂肪性肝病)。3)肝细胞癌，持续发生，无LC(1型糖原贮积症，口服避孕药/合成类固醇的消费)。在第1组和第2组中，达到LC所需的肝细胞毒性水平尚未达到，但致癌效应已经足够强，可能是由于其他致癌物或宿主因素的影响。在第3组中，致癌作用是由肝细胞代谢的长期改变所介导的，这种改变具有低毒作用，不会导致细胞死亡，但仍具有致癌作用。在这些病例中，最初形成肝细胞腺瘤并随后转化为肝细胞癌是常见的发现(腺瘤-癌序列)。
Of hepatocellular carcinomas (HCC), 15-20% occur in the non-cirrhotic liver. All factors which cause HCC when liver cirrhosis (LC) is present, can also lead to HCC without LC. On the basis of the relative frequency, HCC can be roughly differentiated into 3 groups: 1) HCC, rarely occurring without cirrhosis (e.g. virus hepatitis, alcohol abuse). 2) HCC, frequently occurring without LC (alpha1-antiytrypsin deficiency, hemochromatosis, non-alcoholic fatty liver disease). 3) HCC, consistently occurring without LC (glycogen storage disease type 1, consumption of oral contraceptives/anabolic steroids). In groups 1 and 2 the level of hepatocellular toxicity necessary to reach LC is not yet achieved but the carcinogenic effect is already strong enough to induce HCC, possibly owing to the influence of additional carcinogens or host factors. In group 3, the carcinogenic effect is mediated by a long-standing alteration of the hepatocellular metabolism that is of low toxic effect and does not lead to cell death, but is nevertheless carcinogenic. In these cases, the initial formation of hepatocellular adenomas that subsequently transform into HCC is a common finding (adenoma-carcinoma sequence).