Comparative Analysis of Nonalcoholic Steatohepatitis- Versus Viral Hepatitis- and Alcohol-Related Liver Disease-Related Hepatocellular Carcinoma
Comparative Analysis of Nonalcoholic Steatohepatitis- Versus Viral Hepatitis- and Alcohol-Related Liver Disease-Related Hepatocellular Carcinoma
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DOI：
10.6004/jnccn.2018.7105
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发表时间：
2019-04-01
影响因子：
13.4
通讯作者：
Yopp, Adam C.
中科院分区：
文献类型：
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作者：
Hester, Caitlin A.;Rich, Nicole E.;Yopp, Adam C.
背景：尽管非酒精性脂肪性肝炎（NASH）的负担日益增加，但比较 NASH 相关肝细胞癌（HCC）与其他病因的结果的数据有限。方法：收集了 2008 年 1 月至 2016 年 12 月期间在两个大型卫生系统诊断为 NASH、酒精相关性肝病 (ALD)、丙型肝炎病毒 (HCV) 和乙型肝炎病毒 (HBV) 相关 HCC 的 1,051 名患者的患者人口统计和肿瘤特征。比较患者人口统计、临床特征和生存率。使用多变量分析检查风险调整治疗接受情况和总生存期（OS）。结果：共有 92 名 NASH 相关 HCC 患者与 153 名 ALD 患者、719 名 HCV 患者和 87 名 HBV 相关 HCC 患者进行了比较。 NASH 患者年龄较大，更有可能是女性，更有可能是西班牙裔白人。 NASH 和 HBV 患者比 ALD 或 HCV 患者有更多代偿性肝病，其中非肝硬化 HCC 的比例明显更高。尽管监测数据和诊断时巴塞罗那临床肝癌 (BCLC) 肿瘤分期相似，但 NASH 患者的治愈性治疗率高于其他疾病患者。 NASH 的未调整中位 OS 为 16 个月，ALD 为 15 个月，HCV 为 14 个月，HBV 为 8 个月。在多变量分析中，与 ALD 相比，NASH 与较差的 OS 相关（风险比，1.92；95% CI，1.3-2.5），但 NASH 与 HCV 或 HBV 相关 HCC 之间没有差异。结论：与其他疾病相比，NASH 相关 HCC 患者的肝功能保存更完好，包括更高比例的非肝硬化 HCC。尽管患者在诊断时肿瘤分期相似，但与 ALD 相比，NASH 与较差的生存率独立相关，但与 HCV 和 HBV 相比，其生存率相似。
Background: Despite an increasing burden of nonalcoholic steatohepatitis (NASH), limited data are available comparing outcomes of NASH-related hepatocellular carcinoma (HCC) versus other etiologies. Methods: Patient demographic and tumor characteristics were collected for 1,051 patients diagnosed with NASH-, alcohol-related liver disease (ALD)-, hepatitis C virus (HCV)-, and hepatitis B virus (HBV)-related HCC at 2 large health systems from January 2008 through December 2016. Patient demographics, clinical characteristics, and survival were compared. Risk-adjusted treatment receipt and overall survival (OS) were examined using multivariable analysis. Results: A total of 92 patients with NASH-related HCC were compared with 153 patients with ALD-, 719 with HCV-, and 87 with HBV-related HCC. Patients with NASH were older, more likely female, and more likely Hispanic white. Patients with NASH and HBV had more compensated liver disease than those with ALD or HCV, including significantly higher proportions having noncirrhotic HCC. Despite similar surveillance receipt and Barcelona Clinic Liver Cancer (BCLC) tumor stage at diagnosis, patients with NASH had higher rates of curative-intent therapy than those with other diseases. Unadjusted median OS was 16 months for NASH, 15 months for ALD, 14 months for HCV, and 8 months for HBV. In multivariable analysis, NASH was associated with worse OS compared with ALD (hazard ratio, 1.92; 95% CI, 1.3-2.5), but there was no difference between NASH- and HCV- or HBV-related HCC, Conclusions: Patients with NASH-related HCC present with more preserved liver function, including a higher proportion having noncirrhotic HCC, than other diseases. Despite patients having similar tumor stage at diagnosis, NASH is independently associated with worse survival compared with ALD, but similar survival compared with HCV and HBV.