目标:尽管酒精相关肝细胞癌(HCC)的负担随着酒精消耗的增加而增加,尚未对酒精相关性HCC的临床表现和结局进行系统评估.我们的目的是确定患病率,临床特征,监测率,治疗分配,和酒精相关性肝癌的结果。
方法:从开始到2023年1月搜索Medline和Embase。使用广义线性混合模型分析比例数据。通过成对荟萃分析获得比较酒精相关HCC和其他原因的比值比(OR)或平均差异。使用风险比的汇总分析评估生存结果。
结果:在确定的4,824条记录中,共纳入55篇文章(86,345例患者)。总的来说,30.4%(CI:24.0%-37.7%)的HCC与酒精相关,欧洲比例最高,美洲最低。酒精相关性肝癌患者更可能是男性,但是年龄和合并症相似,与其他原因相比。20.8%(CI:11.4%-34.9%)的酒精相关HCC患者接受了监测,而35.0%,31.6%,乙型肝炎病毒占21.4%,丙型肝炎病毒,和代谢功能障碍相关的肝癌,(均P<0.05)。酒精相关HCC的BCLC分期(0/A)(OR:0.7,CI:0.6-0.9;P=0.018)和治愈性治疗(24.5%vs33.9%;OR0.7,CI:0.5-0.9;P=0.003)的可能性较低,与其他原因相比,死亡率更高(HR:1.3,CI:1.1-1.5,P=0.012)。
结论:酒精相关性HCC与较低的监测率相关,更先进的BCLC阶段,接受治愈性治疗的可能性较低,和较差的生存。这些数据要求采取措施减少大量饮酒,并改善高危人群中有效HCC监测的策略。
BACKGROUND: Although the burden of alcohol-associated hepatocellular carcinoma (HCC) is increasing with rising alcohol consumption, clinical presentation and outcomes of alcohol-associated HCC have not been systematically assessed. We aimed to determine the prevalence, clinical characteristics, surveillance rates, treatment allocation, and outcomes of alcohol-associated HCC.
METHODS: Medline and Embase were searched from inception to January 2023. Proportional data were analyzed using a generalized linear mixed model. The odds ratio (OR) or mean difference comparing alcohol-associated HCC and other causes was obtained with pairwise meta-analysis. Survival outcomes were evaluated using a pooled analysis of hazard ratios.
RESULTS: Of 4824 records identified, 55 articles (86,345 patients) were included. Overall, 30.4% (95% confidence interval [CI], 24.0%-37.7%) of HCC was alcohol associated, with the highest proportion in Europe and the lowest in the Americas. People with alcohol-associated HCC were more likely male but were similar in age and comorbidities compared with other causes. A total of 20.8% (95% CI, 11.4%-34.9%) of people with alcohol-associated HCC underwent surveillance compared with 35.0%, 31.6%, and 21.4% in hepatitis B virus, hepatitis C virus, and metabolic dysfunction-associated HCC, respectively (all P < .05). Alcohol-associated HCC had a lower likelihood of Barcelona Clínic Liver Cancer C stage (0/A) (OR, 0.7; 95% CI, 0.6-0.9; P = .018) and curative therapy (24.5% vs 33.9%; OR, 0.7; 95% CI, 0.5-0.9; P = .003), and higher mortality (HR, 1.3; 95% CI, 1.1-1.5; P = .012) when compared with other causes.
CONCLUSIONS: Alcohol-associated HCC is associated with lower surveillance rates, more advanced BCLC stage, lower likelihood of receiving curative therapy, and poorer survival. These data call for measures to reduce heavy alcohol consumption and improve strategies for effective HCC surveillance in high-risk individuals.