Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are biliary tract pathologies with increased risk of HCC, although HCC is more commonly associated with viral hepatitis and steatohepatitis. HCC risk stratification in PBC/PSC populations may help select patients for surveillance. We hypothesized that metabolic syndrome associated diagnoses and co-morbid nonalcoholic fatty liver disease (NAFLD) may be risk factors for HCC in patients with PBC and PSC. We undertook a multi-institutional case control study of PSC (19 cases, 38 controls) and PBC (39 cases and controls) patients with advanced fibrosis, matched for known HCC risk factors of age and sex, who had native liver explant or resection specimens. In the PSC population, HCC risk was significantly associated with multiple metabolic syndrome associated diagnoses (OR 13, p = 0.02), hyperlipidemia (OR 29, p = 0.03), and obesity (OR 6.8, p = 0.01). In the PBC cohort, only type 2 diabetes was a risk factor for HCC (OR 4.7, p = 0.03). In the PSC cohort, thick fibrous septae were associated with HCC risk (OR 3.4, p = 0.04). No other pathologic features of the nonneoplastic liver were significantly associated with HCC, including features of NAFLD such as macrovesicular steatosis, pericellular fibrosis, and steatohepatitis. Metabolic syndrome associated diagnoses, specifically type 2 diabetes among PBC patients, is associated with HCC risk in patients with biliary type cirrhosis. However, we found no evidence that HCC risk is related to co-morbid NAFLD, indicating a likely distinct mechanism of metabolic syndrome-associated carcinogenesis in these populations.

原发性胆汁性胆管炎 (PBC) 和原发性硬化性胆管炎 (PSC) 是增加 HCC 风险的胆道疾病，尽管 HCC 更常与病毒性肝炎和脂肪性肝炎相关。PBC/PSC 人群的 HCC 风险分层可能有助于选择患者进行监测。我们假设与代谢综合征相关的诊断和合并症非酒精性脂肪肝病 (NAFLD) 可能是 PBC 和 PSC 患者发生 HCC 的危险因素。我们对 PSC（19 例，38 例对照）和 PBC（39 例和对照）晚期纤维化患者进行了一项多机构病例对照研究，这些患者与已知的年龄和性别 HCC 危险因素相匹配，这些患者有天然肝外植体或切除标本. 在 PSC 人群中，HCC 风险与多种代谢综合征相关诊断显着相关（OR 13，p  = 0.02)、高脂血症 (OR 29, p  = 0.03) 和肥胖 (OR 6.8, p  = 0.01)。在 PBC 队列中，只有 2 型糖尿病是 HCC 的危险因素（OR 4.7，p  = 0.03）。在 PSC 队列中，厚纤维间隔与 HCC 风险相关（OR 3.4，p = 0.04)。非肿瘤性肝脏的其他病理特征与 HCC 没有显着相关性，包括 NAFLD 的特征，如大泡性脂肪变性、细胞周围纤维化和脂肪性肝炎。代谢综合征相关诊断，特别是 PBC 患者的 2 型糖尿病，与胆汁型肝硬化患者的 HCC 风险相关。然而，我们没有发现 HCC 风险与共病 NAFLD 相关的证据，这表明这些人群中代谢综合征相关的致癌机制可能存在不同的机制。