非酒精性脂肪性肝病对乙肝病毒相关肝细胞癌患者生存的影响

Impact of non-alcoholic fatty liver disease on overall survival in hepatitis B virus-related hepatocellular carcinoma

目的 探讨非酒精性脂肪性肝病(NAFLD)对乙型肝炎病毒(HBV)相关肝细胞癌(HCC)患者生存的影响。方法 纳入2008年6月-2020年12月就诊于解放军总医院第五医学中心的HBV相关HCC患者833例,回顾性收集患者初次诊断HCC时的临床信息及随访资料,根据巴塞罗那肝癌临床(BCLC)分期进行分层,并以是否合并NAFLD分组,采用稳健逆概率处理加权法(IPTW)平衡相关临床指标,采用Kaplan-Meier生存曲线、Log-rank检验及Cox回归比较NAFLD组与非NAFLD组HBV相关HCC患者的预后,研究终点为肝癌相关性死亡。结果 以BCLC分期为标准,本组833例中可切除患者465例,不可切除患者368例;可切除患者中161例(34.6%)合并NAFLD,不可切除患者中76例(20.7%)合并NAFLD。进行稳健IPT W加权后,两组间所有指标差异均无统计学意义。生存分析结果显示,合并NAFLD的HBV相关HCC患者中位生存时间明显长于非NAFLD患者,可切除NAFLD患者3、5、8年累积生存率分别为96.9%、82.1%、41.2%,明显高于非NAFLD患者(分别为91.1%、60.4%、13.7%,P<0.01)。Cox分析结果显示,NAFLD是生存的保护因素(HR=0.473,95%CI0.356~0.627,P<0.01)。在不可切除患者中也获得了类似的结果,合并NAFLD患者3、5、8年累积生存率分别为76.8%、53.7%、18.4%,明显高于非NAFLD患者(分别为53.0%、25.7%、2.5%,P<0.01);单因素Cox分析结果显示,NAFLD是患者生存的保护因素(HR=0.358,95%CI 0.247~0.518,P<0.01)。结论 合并NAFLD的HBV相关HCC患者累积生存率高于未合并NAFLD的患者。

Objective To investigate the effect of non-alcoholic fatty liver disease(NAFLD) on the overall survival of patients with hepatitis B virus-related hepatocellular carcinoma(HCC). Methods The hospitalized patients from June 2008 to December 2020 were screened according to inclusive and exclusive criteria, the clinical characteristics at the time of the initial diagnosis of HCC and time-to-event information of the enrolled patients were retrospectively collected. After stratified by the Barcelona Clinic Liver Cancer(BCLC) staging and then balanced with the stabilized inverse probability of treatment weighting(IPTW) between NAFLD and non-NAFLD group, the Kaplan-Meier survival curve, log-rank test and Cox regression were used to compare the prognosis of patients with HBV-related HCC between NAFLD group and non-NAFLD group. The endpoint of this study was HCC-related death. Results A total of 833 patients were enrolled in the study. Among them, 465 patients in resectable group and 368 in non-resectable group. There were 161(34.6%) patients with NAFLD in resectable group, and 76(20.7%) patients with NAFLD in non-resectable group. After stabilized IPTW weighting, all indicators showed no statistical difference between two groups. Survival analyses showed that median survival time of NAFLD patients with HBV-related HCC was significantly longer than that of non-NAFLD patients. The 3-, 5-, and 8-year cumulative survival rates of NAFLD patients in resectable group were 96.9%, 82.1% and 41.2%, which were significantly higher than 91.1%, 60.4% and 13.7% of non-NAFLD patients(P<0.01). Cox analysis showed that NAFLD was the protective factor of survive(HR=0.473, 95%CI 0.356-0.627, P<0.01). Similarly, those of NAFLD patients in non-resectable group were 76.8%, 53.7% and 18.4%, which were significantly higher than those of non-NAFLD patients(53.0%, 25.7% and 2.5%, respectively, P<0.01). Cox analysis also showed that NAFLD was the protective factor of survive(HR=0.358, 95%CI 0.247-0.518, P<0.01). Conclusion The cumulative survival rate of HBV-related HCC patients with NAFLD is higher than that of patients without NAFLD.