非酒精性脂肪性肝炎相关肝细胞癌111例临床荟萃分析

摘要

目的 总结非酒精性脂肪性肝炎(NASH)基础上肝癌的临床特征.方法 对以"fatty liver、NASH、liver cancer、HCC"等为关键词,在Pubmed、Medline、OVID数据库检索得到的1990至2010年发表的22篇文献中111例NASH基础上肝癌患者的临床资料进行汇总分析.结果 (1)发现肝功能异常的年龄为60岁,诊断NASH的年龄为63.9岁,诊断肝细胞癌(HCC)的年龄66.7岁;(2)男性占62%,男女之比1.64:1;(3)79%患者伴有肥胖,78%伴有糖尿病,33%伴有血脂异常,52%伴有高血压;(4)71%患者肿瘤为单发,肿瘤直径最小1.0 cm,最大13 cm(平均3.3 cm);(5)大多数肿瘤发生在肝右叶;(6)67%HCC伴肝硬化,肿瘤组织以梁索型居多,分化程度多为良好～中分化;(7)多数患者无任何症状,常规体检时发现肿瘤;(8)65%病例AFP和/或PIVKAII升高;(9)大多数病例经手术切除治疗,术后平均随访24个月,21%患者死亡,15%复发.结论 NASH基础上HCC多见于男性,这类患者往往伴有代谢性疾病,尽管肿瘤分化程度较高,根治性切除率高,NASH无痛性进展使得大多患者发现肝癌已属晚期,导致预后相对较差.有必要对合并多元代谢紊乱的NASH患者,尤其是男性和年老患者进行定期HCC筛检.%Objective To summarize the clinical features of patients with nonalcoholic steatohepatitis (NASH)-associated hepatacellular carcinoma (HCC).Methods Systematic analysis of clinical data of 111 patients with NASH-associated HCC from 22 studies published from 1990 to 2010 by searching Pubmed, Medline, OVID databases.Results 69 patients were male (62％).Mean age at onset of abnormal liver function test and diagnosis of NASH and HCC was respectively 60, 63.9 and 66.7 years.Most patients were obese (79％) and diabetic (78％), 33％ of patients had dyslipidemia and 52％ had hypertension.98.6％(71/72) of cases complicated with at least one metabolic disease.71％ of patients had a single nodule, the tumors ranged from 1.0 to 13 cm in diameter (mean, 3.3 cm) and often showed well to moderately-differentiated HCC with steatosis and Mallory bodies.Most nodules located in the right lobe of liver.33％ of cases showed non-cirrhosis in non-cancerous areas.Most patients had no abnormal clinical manifestations but found tumor by routine health examination.65％ of cases exhibited elevation of AFP and/or PIVKAⅡ.51％ (38/74) of cases underwent hepatectomy, 25％ (19/74) received liver transplantation.During the mean follow-up of 24 months, 21％ of patients died (11/51), 15％ recurred.Conclusion NASH-associated HCC was common in male.These patients were usually accompanied by metabolic diseases.Although most patients had good tumor differentiation and high radical resection rate, they might not find tumor until late stage, which caused relatively poor prognosis because of indolent progressive course of NASH.Regular screening for HCC is necessary for NASH patients, especially the elderly men with multiple metabolic disorders.