基于脂肪肝风险分层的肝细胞癌发病率精准医疗:一项真实世界的全国性纵向研究。

IF 15.8 1区 医学 Q1 Medicine
PLoS Medicine Pub Date : 2024-10-25 eCollection Date: 2024-10-01 DOI:10.1371/journal.pmed.1004479
Rongtao Lai, Scott Barnett, Xinrong Zhang, Leslie Yeeman Kam, Ramsey Cheung, Qing Xie, Mindie H Nguyen
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引用次数: 0

摘要

背景:与脂肪性肝病(SLD)相关的肝细胞癌(HCC)的详细亚组发病率对于为实践和公共卫生干预提供信息至关重要,但该数据仍然稀少。我们旨在填补这一空白:在一项对美国 Merative Marketscan 研究数据库(2007 年 1 月 1 日至 2021 年 12 月 12 日)中患有 SLD 的成人进行的回顾性队列研究中,我们估算了按性别、年龄、肝硬化、糖尿病(DM)以及所有这 4 个因素的组合进行分层的 HCC 发病率。我们排除了大量饮酒和慢性病毒性肝炎患者。我们分析了 741,816 名 SLD 患者(平均年龄为 51.5 ± 12.8 岁,46% 为男性,14.7% 为肝硬化)的数据。在 2,410,166 人年的随访期间,1,740 名患者发展为 HCC。总的 HCC 发病率为 0.72‰(95% 置信区间 [CI,0.68, 0.75])。男性发病率(0.95,95% CI [0.89,1.01])高于女性(0.52,95% CI [0.48,0.56])(P < 0.001)。肝硬化患者的发病率为 4.29(95% CI [4.06,4.51]),明显高于非肝硬化患者(0.14,95% CI [0.13,0.16])(P < 0.001)。此外,与非糖尿病患者(0.41,95% CI [0.38,0.44])相比,糖尿病患者的发病率更高(1.19,95% CI [1.12,1.26])(P < 0.001)。慢性肾脏病(CKD)也与较高的 HCC 发病率有关,与无慢性肾脏病者相比,HCC 发病率为 2.20(95% CI [2.00,2.41])(0.58,95% CI [0.55,0.62])(P < 0.001)。同样,与无心血管疾病的患者(0.51,95% CI [0.48,0.54])相比,患有心血管疾病的患者的 HCC 发病率更高,为 1.89(95% CI [1.75,2.03])(p < 0.001)。最后,与没有其他癌症的患者(0.29,95% CI [0.26,0.31])相比,非肝癌患者的 HCC 发病率(3.90,95% CI [3.67,4.12])明显更高(P < 0.001)。进一步分层后,HCC发病率按10年年龄间隔、男性性别、肝硬化和糖尿病递增,男性和女性分别达到19.06(95% CI [16.10,22.01])和8.44(95% CI [6.78,10.10]),但非糖尿病、非肝硬化的老年结论仅为0.04:这项全国范围的研究提供了按几个关键风险因素分层的与 SLD 相关的 HCC 发病率的可靠估算数据。除肝硬化外,未来的监测策略、预防、公共卫生措施和未来的研究模型还应考虑性别、年龄和 DM 的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Incidence rates of hepatocellular carcinoma based on risk stratification in steatotic liver disease for precision medicine: A real-world longitudinal nationwide study.

Background: Detailed subgroup incidence rates for steatotic liver disease (SLD)-related hepatocellular carcinoma (HCC) are critical to inform practice and public health interventions but remain sparse. We aimed to fill in this gap.

Methods and findings: In a retrospective cohort study of adults with SLD from the United States (US) Merative Marketscan Research Databases (1/2007 to 12/2021), we estimated HCC incidence stratified by sex, age, cirrhosis, diabetes mellitus (DM), and a combination of all these 4 factors. We excluded patients with significant alcohol use and chronic viral hepatitis. We analyzed data from 741,816 patients with SLD (mean age 51.5 ± 12.8 years, 46% male, 14.7% cirrhosis). During a 2,410,166 person-years (PY) follow-up, 1,740 patients developed HCC. The overall HCC incidence yielded 0.72 per 1,000 PY (95% confidence interval [CI, 0.68, 0.75]). The incidence was higher in males (0.95, 95% CI [0.89, 1.01]) compared to females (0.52, 95% CI [0.48, 0.56]) (p < 0.001). For those with cirrhosis, the incidence was significantly higher at 4.29 (95% CI [4.06, 4.51]) compared to those without cirrhosis (0.14, 95% CI [0.13, 0.16]) (p < 0.001). Additionally, the incidence was higher in patients with DM (1.19, 95% CI [1.12, 1.26]) compared to those without DM (0.41, 95% CI [0.38, 0.44]) (p < 0.001). Chronic kidney disease (CKD) was also associated with a higher HCC incidence of 2.20 (95% CI [2.00, 2.41]) compared to those without CKD (0.58, 95% CI [0.55, 0.62]) (p < 0.001). Similarly, individuals with cardiovascular disease (CVD) had a higher HCC incidence of 1.89 (95% CI [1.75, 2.03]) compared to those without CVD (0.51, 95% CI [0.48, 0.54]) (p < 0.001). Finally, the incidence of HCC was significantly higher in patients with non-liver cancer (3.90, 95% CI [3.67, 4.12]) compared to those without other cancers (0.29, 95% CI [0.26, 0.31]) (p < 0.001). On further stratification, HCC incidence incrementally rose by 10-year age intervals, male sex, cirrhosis, and DM, reaching 19.06 (95% CI [16.10, 22.01]) and 8.44 (95% CI [6.78, 10.10]) in males and females, respectively, but only 0.04 for non-diabetic, noncirrhotic aged <40 years patients in both sexes. The main limitation of this methodology is the potential misclassification of the International Classification of Diseases (ICD) codes inherent in claims database studies.

Conclusions: This nationwide study provided robust granular estimates for SLD-related HCC incidence stratified by several key risk factors. In addition to cirrhosis, future surveillance strategies, prevention, public health initiatives, and future research models should also take into account the impact of sex, age, and DM.

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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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