脂肪肝是引起肝癌的原因


  【24drs.com】一篇新研究显示,非酒精性脂肪肝变成美国的肝细胞癌主因;事实上,从2004至2009年,脂肪肝患者的肝细胞癌发生率逐年增加约5%。
  
  维吉尼亚州福尔斯彻奇Inova医疗体系的Zobair Younossi医师表示,脂肪肝患者发生肝癌时,存活期比B型或C型肝炎相关罹癌之患者短;他报告指出,脂肪肝相关癌症者的诊断分期都比较恶化,肝移植比较不可能。
  
  Younossi医师在2015肝脏研讨会中表示,基于非酒精性脂肪肝的流行病学,疾病相关并发症预期会上升。
  
  脂肪肝影响约25%的美国人口,约2%至3%的人会恶化成非酒精性脂肪性肝炎。
  
  Younossi医师表示,我怀疑非酒精性脂肪性肝炎患者处于这个不良结果的风险。他解释,在2015年,确认脂肪性肝炎诊断的唯一方法是肝切片;因为切片是侵入性的,只有少数病患进行,因此,有许多非酒精性脂肪性肝炎患者未被诊断;而且可能无法确认晚期肝纤维化患者处于肝细胞癌风险。
  
  他的建议是,确认脂肪肝病患是否有脂肪性肝炎相关的晚期纤维化或肝硬化;如果有,他们应每6个月进行肝细胞癌筛检。
  
  Younossi医师等人于2004年到2009年时,从「流行病监测及最终结果(Surveillance, Epidemiology, and End Results [SEER])」的Medicare资料库中检视了5,748名肝细胞癌患者,以及17,244名没有癌症的对照组。
  
  与C型肝炎有关的肝癌比率为48%,与脂肪肝有关的是26%,与酒精性肝脏疾病有关的是14%,与B型肝炎有关的是8%,与自体免疫型肝炎或胆汁性肝硬化有关的是4%。
  
  在这段研究期间,肝细胞癌案例数逐年增加;与脂肪有关的癌症逐年增加,这有相当比率是因为与其它原因有关的肝细胞癌增加。
  
  脂肪肝相关癌症的患者在诊断时的年龄,比B型或C型肝炎相关癌症患者年长(72岁 vs 66岁)、比较可能是白人、比较可能有未分期或恶化的肿瘤,此外,脂肪肝相关癌症患者的存活平均少4个月(P< .05)。
  
  多变项分析中,男性及非白人或非黑人种族与癌症独立相关,且有较高的Charlson共病症指数分数、有B型肝炎、C型肝炎或脂肪肝。
  
  诊断一年内,与脂肪肝有关的肝细胞癌患者比与B型或C型肝炎有关者多(62% vs 50%;P< .05),最常见的致死原因为癌症或肝脏疾病(96.3%),接著是心因性死亡(3.7%)。
  
  有癌症的患者中,与一年死亡率有关的因素,包括较年长、收入少、肿瘤未分期、具有Medicare保险资格、患有末期肾病、患有脂肪肝,而一年死亡率的对抗因素则是有进行肝脏移植以及局部肿瘤。
  
  会议主持人、葡萄牙里斯本大学医院Helena Cortez-Pinto医师表示,这是相当重要的研究,因为病患样本数相当多;脂肪肝相关癌症在侦测上特别有挑战性,因为它可能在没有肝硬化时发生;你不可能监测所有脂肪肝患者,那将会是非常大的负担。
  
  但是,要记住这个可能性,特别是肥胖患者。Cortez-Pinto医师解释,我们必须了解,脂肪肝患者有可能在没有肝硬化的情况下发生癌症的可能性。我们不知道这个情况的实际比率,但它确实存在。如果有任何怀疑时,要转介病患进行后续检查。
  
  Cortez-Pinto医师表示,脂肪肝相关癌症的死亡率不令人惊讶,但是并未在所有研究皆有探讨,研究结果可能是因为脂肪肝病患没有良好的癌症监测。如果在肝硬化监测时发现肿瘤,比较可能会被追踪。
  
  Younossi医师表示他同意这个论点,脂肪肝与比较短的存活有关,因为这些病患发现时,是已经比较病重、恶化的癌症。或许是因为他们没有进行筛检,或筛检时的超音波没有发现到被脂肪肝内脏性肥胖盖住的小癌症病灶。此外,因为他们的共病症,他们无法进行肝脏移植。
  
  资料来源:http://www.24drs.com/
  
  Native link:Fatty Liver Disease Surging as Liver Cancer Cause

Fatty Liver Disease Surging as Liver Cancer Cause

By Miriam E. Tucker
Medscape Medical News

VIENNA — Nonalcoholic fatty liver disease is emerging as a major cause of hepatocellular carcinoma in the United States, a new study shows.

In fact, from 2004 to 2009, the annual increase in hepatocellular carcinoma in fatty liver disease patients was approximately 5%.

Survival is shorter for patients with fatty liver who develop cancer than it is for patients with hepatitis B or hepatitis C who develop hepatocellular carcinoma, said Zobair Younossi, MD, from the Inova Health System in Falls Church, Virginia.

Tumor stage is also more advanced at diagnosis in patients with fatty-liver-associated carcinoma, and liver transplantation is less common, he reported.

"Given the epidemic of nonalcoholic fatty liver, the burden of disease-related complications is expected to rise," Dr Younossi said here at the Liver Congress 2015.

Fatty liver disease affects about 25% of the population in the United States. About 2% to 3% of the population has the progressive form of the disease — nonalcoholic steatohepatitis.

"I suspect it is the nonalcoholic steatohepatitis patients who are primarily at risk for adverse outcomes," Dr Younossi told Medscape Medical News. "In 2015, the only way to confidently establish the diagnosis of steatohepatitis is by a liver biopsy. Because biopsy is invasive, it is done in the small minority of patients. Therefore, a large number of patients with nonalcoholic steatohepatitis are undiagnosed," he explained.

"And there may not be a recognition that patients with advanced fibrosis are at risk for hepatocellular carcinoma," he added.

His recommendation is to "determine if a patient with fatty liver has steatohepatitis-related advanced fibrosis or cirrhosis. If so, they should be screened for hepatocellular carcinoma every 6 months."

More Deaths

From 2004 to 2009, Dr Younossi and colleagues identified 5748 hepatocellular carcinoma patients and 17,244 control subjects without cancer from the Surveillance, Epidemiology, and End Results (SEER)–Medicare database.

The liver cancer was related to hepatitis C in 48% of the cases, to fatty liver in 26%, to alcoholic liver disease in 14%, to hepatitis B in 8%, and to autoimmune hepatitis or biliary cirrhosis in 4%.

This is a very important study because of the very large number of patients.

The number of cases of hepatocellular carcinoma increased each year during the study period. Annual increases in fatty-related cancers were proportionate to increases in hepatocellular carcinoma related to other causes.

Patients with fatty-liver-related cancer were older at diagnosis than patients with cancer related to hepatitis B or C (72 vs 66 years), were more likely to be white, and were more likely to have unstaged or advanced tumors. In addition, average survival was 4 months shorter in patients with fatty-liver-related cancer (P < .05).

On multivariate analysis, being male and being of a nonwhite or nonblack race were independently associated with cancer, as were having a high Charlson Comorbidity Index score and the presence of hepatitis B, hepatitis C, or fatty liver.

More patients with hepatocellular carcinoma related to fatty liver than related to hepatitis B or C died within 1 year of diagnosis (62% vs 50%; P < .05). The most common cause of death was cancer or liver disease (96.3%), followed by cardiac death (3.7%).

For patients with cancer, factors associated with 1-year mortality were being older, having a lower income, having an unstaged tumor, being eligible for Medicare, having end-stage renal disease, and having fatty liver. Factors protective against 1-year mortality were having undergone liver transplantation and having a localized tumor.

"This is a very important study because of the very large number of patients," said session moderator Helena Cortez-Pinto, MD, from the University Hospital of Lisbon in Portugal.

Fatty-liver-associated cancer is particularly challenging to detect because it can occur in the absence of cirrhosis. "You can't do surveillance of all patients with fatty liver; that would be a very high burden," she told Medscape Medical News.

But the possibility should be kept in mind, particularly with obese patients. "We have to recognize that there is the possibility of patients with fatty liver developing cancer even in the absence of cirrhosis. We don't know exactly how frequent this is, but it exists," Dr Cortez-Pinto explained. "If there is any kind of suspicion, refer patients for further investigation."

The mortality rate for fatty-liver-associated cancer is rather surprising, and hasn't been seen in all studies, said Dr Cortez-Pinto. The finding is likely the result of the poor cancer surveillance in fatty liver patients. "If a tumor is discovered during cirrhosis surveillance, it is more likely to be monitored," she pointed out.

Dr Younossi said he agrees with that. "Fatty liver is associated with shorter survival because by the time these patients present clinically, they have advanced cancer. The reason may be that they don't undergo screening or that screening ultrasound fails to detect small cancers with fatty liver visceral obesity."

And, he added, "because of their comorbidities, they don't undergo liver transplant."

Dr Younossi is a consultant to Gilead, BMS, Intercept, GSK, AbbVie, and Salix. Dr Cortez-Pinto reports receiving consulting fees from Intercept and Janssen.

European Association for the Study of the Liver (EASL) International Liver Congress 2015. Presented April 24, 2015.

    
相关报导
第二型糖尿病患超过60%患有脂肪肝疾病
2015/10/16 上午 10:11:47
即便BMI低 久坐仍与脂肪肝疾病有关
2015/10/2 上午 10:37:49
脂肪肝与糖尿病及动脉粥状硬化有密切关联
2014/4/21 上午 10:54:52

上一页
   1   2   3   4   5   6   7   8   9   10  
回上一页