脂肪肝是引起肝癌的原因


  【24drs.com】一篇新研究顯示,非酒精性脂肪肝變成美國的肝細胞癌主因;事實上,從2004至2009年,脂肪肝患者的肝細胞癌發生率逐年增加約5%。
  
  維吉尼亞州福爾斯徹奇Inova醫療體系的Zobair Younossi醫師表示,脂肪肝患者發生肝癌時,存活期比B型或C型肝炎相關罹癌之患者短;他報告指出,脂肪肝相關癌症者的診斷分期都比較惡化,肝移植比較不可能。
  
  Younossi醫師在2015肝臟研討會中表示,基於非酒精性脂肪肝的流行病學,疾病相關併發症預期會上升。
  
  脂肪肝影響約25%的美國人口,約2%至3%的人會惡化成非酒精性脂肪性肝炎。
  
  Younossi醫師表示,我懷疑非酒精性脂肪性肝炎患者處於這個不良結果的風險。他解釋,在2015年,確認脂肪性肝炎診斷的唯一方法是肝切片;因為切片是侵入性的,只有少數病患進行,因此,有許多非酒精性脂肪性肝炎患者未被診斷;而且可能無法確認晚期肝纖維化患者處於肝細胞癌風險。
  
  他的建議是,確認脂肪肝病患是否有脂肪性肝炎相關的晚期纖維化或肝硬化;如果有,他們應每6個月進行肝細胞癌篩檢。
  
  Younossi醫師等人於2004年到2009年時,從「流行病監測及最終結果(Surveillance, Epidemiology, and End Results [SEER])」的Medicare資料庫中檢視了5,748名肝細胞癌患者,以及17,244名沒有癌症的對照組。
  
  與C型肝炎有關的肝癌比率為48%,與脂肪肝有關的是26%,與酒精性肝臟疾病有關的是14%,與B型肝炎有關的是8%,與自體免疫型肝炎或膽汁性肝硬化有關的是4%。
  
  在這段研究期間,肝細胞癌案例數逐年增加;與脂肪有關的癌症逐年增加,這有相當比率是因為與其他原因有關的肝細胞癌增加。
  
  脂肪肝相關癌症的患者在診斷時的年齡,比B型或C型肝炎相關癌症患者年長(72歲 vs 66歲)、比較可能是白人、比較可能有未分期或惡化的腫瘤,此外,脂肪肝相關癌症患者的存活平均少4個月(P< .05)。
  
  多變項分析中,男性及非白人或非黑人種族與癌症獨立相關,且有較高的Charlson共病症指數分數、有B型肝炎、C型肝炎或脂肪肝。
  
  診斷一年內,與脂肪肝有關的肝細胞癌患者比與B型或C型肝炎有關者多(62% vs 50%;P< .05),最常見的致死原因為癌症或肝臟疾病(96.3%),接著是心因性死亡(3.7%)。
  
  有癌症的患者中,與一年死亡率有關的因素,包括較年長、收入少、腫瘤未分期、具有Medicare保險資格、患有末期腎病、患有脂肪肝,而一年死亡率的對抗因素則是有進行肝臟移植以及局部腫瘤。
  
  會議主持人、葡萄牙里斯本大學醫院Helena Cortez-Pinto醫師表示,這是相當重要的研究,因為病患樣本數相當多;脂肪肝相關癌症在偵測上特別有挑戰性,因為它可能在沒有肝硬化時發生;你不可能監測所有脂肪肝患者,那將會是非常大的負擔。
  
  但是,要記住這個可能性,特別是肥胖患者。Cortez-Pinto醫師解釋,我們必須瞭解,脂肪肝患者有可能在沒有肝硬化的情況下發生癌症的可能性。我們不知道這個情況的實際比率,但它確實存在。如果有任何懷疑時,要轉介病患進行後續檢查。
  
  Cortez-Pinto醫師表示,脂肪肝相關癌症的死亡率不令人驚訝,但是並未在所有研究皆有探討,研究結果可能是因為脂肪肝病患沒有良好的癌症監測。如果在肝硬化監測時發現腫瘤,比較可能會被追蹤。
  
  Younossi醫師表示他同意這個論點,脂肪肝與比較短的存活有關,因為這些病患發現時,是已經比較病重、惡化的癌症。或許是因為他們沒有進行篩檢,或篩檢時的超音波沒有發現到被脂肪肝內臟性肥胖蓋住的小癌症病灶。此外,因為他們的共病症,他們無法進行肝臟移植。
  
  資料來源: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.

    
相關報導
第二型糖尿病患超過60%患有脂肪肝疾病
2015/10/16 上午 10:11:47
即便BMI低 久坐仍與脂肪肝疾病有關
2015/10/2 上午 10:37:49
脂肪肝與糖尿病及動脈粥狀硬化有密切關聯
2014/4/21 上午 10:54:52

上一頁
   1   2   3   4   5   6   7   8   9   10  
回上一頁