创作:玉龙潭 审核:aluba 2018年09月24日
  • 纳入296707名非酒精性脂肪性肝病(NAFLD)患者、296707名健康对照进行回顾性队列研究,前者的肝细胞癌发病率显著升高;
  • NAFLD中肝硬化患者的肝细胞癌发病率最高,NAFLD相关的肝细胞癌患者中有80%是由肝硬化发展而致;
  • 西班牙老龄肝硬化患者患肝细胞癌的风险最高;
  • 首次量化了大数据、地理和种族多样化的NAFLD患者队列中患肝细胞癌的绝对风险,高于一般临床人群,且大多数是由肝硬化发展而成,需提高对该部分人群的监测。
Gastroenterology [IF:22.682]

Risk of Hepatocellular Cancer in Patients with Non-alcoholic Fatty Liver Disease



2018-08-22, Article

Abstract & Authors:展开

BACKGROUND: There are limited data on the risk of hepatocellular cancer (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). We aimed to estimate the risk of incident HCC among patients with NAFLD.
METHODS: We conducted a retrospective cohort study from a total of 130 facilities in the Veterans Health Administration. Patients with NAFLD diagnosed between 1/1/2004 and 12/31/2008 were included and followed until HCC diagnosis, death or 12/31/2015. We also identified a gender and age-matched control cohort without NAFLD. We ascertained all new HCC cases from the Central Cancer Registry and manual chart reviews. We calculated incidence rates for HCC by NAFLD status as well as in subgroups of NAFLD patients. We used competing risk models to compare the risk of HCC in patients with vs. those without NAFLD. We reviewed electronic medical records of all HCC cases that developed in NAFLD patients without cirrhosis.
RESULTS: We compared 296,707 NAFLD patients with 296,707 matched controls. During 2,382,289 person-years [PY] of follow-up, 490 NAFLD patients developed HCC (0.21/1000 PY). HCC incidence was significantly higher among NAFLD patients vs. controls (0.02/1000 PY; hazard ratio, 7.62, 95% confidence interval=5.76-10.09). Among patients with NAFLD, those with cirrhosis had the highest annual incidence of HCC (10.6 /1000 PY). Among patients with NAFLD cirrhosis, HCC risk ranged from 1.6 to 23.7 per 1000 PY based on other demographic characteristics; the risk of HCC was the highest in older Hispanics with cirrhosis. In medical record reviews, 20% of NAFLD patients with HCC had no evidence of cirrhosis.
CONCLUSIONS: Risk of HCC was higher in NAFLD patients than that observed in general clinical population. Most HCC cases in NAFLD developed in patients with cirrhosis. The absolute risk of HCC was higher than the accepted thresholds for HCC surveillance for most patients with NAFLD cirrhosis.

First Authors:
Fasiha Kanwal

Correspondence Authors:
Fasiha Kanwal

All Authors:
Fasiha Kanwal,Jennifer R Kramer,Srikar Mapakshi,Yamini Natarajan,Maneerat Chayanupatkul,Peter A Richardson,Liang Li,Roxanne Desiderio,Aaron P Thrift,Steven M Asch,Jinna Chu,Hashem B El-Serag