CHARACTERISTIC DIFFERENCE OF HEPATOCELLULAR-CARCINOMA BETWEEN HEPATITIS-B AND HEPATITIS-C VIRAL-INFECTION IN JAPAN
CHARACTERISTIC DIFFERENCE OF HEPATOCELLULAR-CARCINOMA BETWEEN HEPATITIS-B AND HEPATITIS-C VIRAL-INFECTION IN JAPAN
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DOI：
10.1002/hep.1840220403
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发表时间：
1995-10-01
期刊：
影响因子：
13.5
通讯作者：
OMATA, M
中科院分区：
文献类型：
--
作者：
SHIRATORI, Y;SHIINA, S;OMATA, M
本文从日本肝炎病毒感染的角度分析了1990~1993年连续205例肝细胞癌患者的临床特点。205例肝细胞癌患者中，单纯丙型肝炎病毒抗体阳性者占71%，丙型肝炎病毒/乙肝病毒抗体同时阳性者占13%，单纯乙肝表面抗原阳性者占11%，两种抗体均阴性者仅占4%。丙型肝炎病毒抗体和乙肝表面抗原同时阳性者仅占1%，HCVAb阳性和丙型肝炎病毒/乙肝病毒抗体均阳性的肝癌患者的平均检出年龄为62+/-7岁，而合并乙肝表面抗原的肝癌患者的平均检出年龄为52+/-13岁(P<；0.05)。丙型肝炎病毒抗体阳性组男女比例为3.3：1，而丙型肝炎病毒/乙肝病毒抗体阳性组为5.5：1，乙肝表面抗原阳性组为7：1，性别分布差异无统计学意义。60%以上的HCVAb阳性肝细胞癌和丙型肝炎病毒/HBVAb阳性肝细胞癌为Child B、C期，而65%的HBs Ag阳性肝细胞癌为Child A期。肝组织学检查证实肝组织病变的严重程度，即肝组织学检查显示，肝组织中有70%以上的HCVAb阳性肝细胞癌和丙型肝炎病毒/HBVAb阳性肝细胞癌表现为肝硬变，而HBs Ag阳性肝细胞癌的肝硬变发生率为50%。丙型肝炎病毒抗体阳性的肝细胞癌和乙肝病毒/丙型肝炎病毒抗体阳性的肝细胞癌的三年生存率分别为68%和56%，而乙肝表面抗原阳性的肝细胞癌的三年生存率为47%。在事先定期体检的患者中，肝癌是早期发现的，这些患者的预后明显好于没有接受体检的患者。从这些结果来看，在日本，丙型肝炎病毒相关的肝细胞癌占全部肝细胞癌的80%以上，与乙肝表面抗原阳性的肝细胞癌相比，这些肝细胞癌的特点是年龄更大，肝硬变更严重。丙型肝炎病毒抗体阳性的肝细胞癌的预后并不明显好于乙肝表面抗原阳性的肝细胞癌，但定期筛查自然会改善预后，因为这些病例通常发现得更早(提前时间偏倚)，且大多属于慢进型(长度偏倚)。
Characteristics of 205 consecutive patients with hepatocellular carcinoma (HCC) admitted during 1990 to 1993 have been analyzed from the standpoint of hepatitis viral infection in Japan. Among 205 HCC patients, 71% of the patients showed positivity for hepatic C virus (HCV) antibody alone, 13% showed positivity both for HCV and HBV (HCV/HBV) antibody, 11% demonstrated HBsAg alone, and negativity of both HCV and HBV antibody in 4% only. Positivity to both HCV antibody and HBsAg was demonstrated in 1% only, Mean detection age of HCVAb-positive HCC as well as both HCV/HBV antibody-positive HCC was 62 +/- 7 years, in contrast to 52 +/- 13 years in HCC with HBsAg (P < .05). Male-to-female ratio among HCVAb-positive HCC was 3.3:1, in contrast to 5.5:1 among the HCV/HBVAb-positive HCC and 7:1 among HBsAg-positive HCC, but there was no significant difference in the gender distribution between these groups. More than 60% of HCVAb-positive HCC and HCV/HBVAb-positive HCC were classified into the stage of Child B and C, whereas 65% of HBsAg-positive HCG was at the stage of Child A. The severity of liver disease was confirmed by liver histology, indicating that more than 70% of the HCVAb-positive HCC and the HCV/HBVAb-positive HCC showed cirrhosis, in contrast to 50% among the HBsAg-positive HCC. Three-year survival rate of HCV Ab-positive HCC and HBV/HCVAb-positive HCC was 68% and 56%, respectively, in contrast to 47% in HBsAg-positive HCC. HCC was found at early stage among the patients receiving periodic medical checkups beforehand, and the prognosis of these HCC patients was significantly better than those who did not receive checkups. From these results, HCV-related HCC occupied over 80% of total HCC in Japan, which are characterized by older age and more severe cirrhosis, as compared with HBsAg-positive HCC. Prognosis of HCV Ab-positive HCC was not significantly better than HBsAg-positive HCC, but the periodical screening naturally improves prognosis because the cases are found usually much earlier (lead time bias) and mostly belong to slow progression type (length bias).