美国癌症学会官方杂志Cancer杂志2013年第一期（Cancer. 2013 Jan 1;119(1):126-35) 发表了山东大学齐鲁医院普外科李涛副教授与复旦大学中山医院肝脏外科合作研究结果。

近年来，随着乙肝疫苗的普及，乙肝肝癌患者发病率有所控制，而随着生活方式的改变，肥胖导致的非酒精性肝炎以及饮酒导致的酒精性肝硬化引起的非肝炎性肝细胞肝癌的发病率持续上升，但是目前国际上对于非肝炎性肝细胞肝癌的了解甚少。此研究系统探索了手术切除的3925例乙肝肝癌患者与675例非肝炎性肝癌患者的临床病理特点的差异，以及手术切除后不同的预后及复发的危险因子，对于早期判断非肝炎性肝癌的预后及术后复发具有重要的临床价值。

Cancer. 2013 Jan 1;119(1):126-35. doi: 10.1002/cncr.27697. Epub 2012 Jun 26.

Hepatitis B virus surface antigen-negative and hepatitis C virus antibody-negative hepatocellular carcinoma:clinical characteristics, outcome, and risk factors for early and late intrahepatic recurrence after resection.

Li T, Qin LX, Gong X, Zhou J, Sun HC, Qiu SJ, Ye QH, Wang L, Fan J.

Source

Department of General Surgery, Qilu Hospital, Shandong University, Jinan, People's Republic of China.

Abstract

BACKGROUND:

Although the incidence of hepatitis B virus surface antigen (HBsAg)-negative/hepatitis C virus antibody (HCVAb)-negativehepatocellular carcinoma (NBNC-HCC) is gradually increasing, it has been mostly ignored in previous studies. The objective of this exploratory study was to investigate the clinicopathologic characteristics and prognostic factors that influence recurrence and survival in patients with NBNC-HCC.

METHODS:

A retrospective analysis was performed of 675 patients with NBNC-HCC and 3529 patients with HBsAg-positive/HCVAb-negative HCC (BNC-HCC) who underwent curative resection between 1997 and 2009. Intrahepatic recurrences were classified into early (≤1 year) and late (>1 year) recurrences. Multivariate competing risks analyses with Bonferroni correction were used to evaluate independent prognostic factors.

RESULTS:

There were no significant differences between the NBNC-HCC and BNC-HCC groups regarding overall survival, cumulative incidence of HCC-specific death, and recurrence. However, the patients with NBNC-HCC were much older (P < .001), were associated less often with cirrhosis or elevated α-fetoprotein levels (P < .001), and had a much lower ratio of men to women (P < .001). NBNC-HCC tumors were larger (P < .001), but were involved less often with vascular invasion (P = .004). Women, serum γ-glutamyl transpeptidase level, tumor size, tumor capsule, and tumor differentiation were identified as independent risk factors for HCC-specific survival in patients with NBNC-HCC. The cumulative incidence of HCC-specific death for women with NBNC-HCC was significantly greater than for men with NBNC-HCC (P < .001).Tumor capsule and vascular invasion were identified as independent risk factors for early recurrence of NBNC-HCC, whereas tumor differentiation was identified as the only significant riskfactor for late recurrence.

CONCLUSIONS:

Patients who had NBNC-HCC had characteristics and prognostic factors that differed from those in patients who had BNC-HCC. Women with NBNC-HCC should be more closely monitored, and it may be worthwhile to evaluate estrogen administration for the maintenance of sex hormone balance and to improve these poor outcomes.

PMID: 22736338 [PubMed - indexed for MEDLINE]