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越来越多的研究结果证实，非酒精性脂肪性肝脏疾病（非酒精脂肪肝）除了与肝癌相关，还与肝脏以外的癌症相关。非酒精脂肪肝与乳腺癌具有相似的风险因素，例如肥胖。不过，非肥胖女性也有可能发生非酒精脂肪肝与乳腺癌。 2019年1月9日，意大利胃肠疾病学会和意大利肝脏研究学会《消化与肝脏疾病》在线发表韩国首尔大学、美国斯坦福大学的研究报告，调查了非酒精脂肪肝与女性乳腺癌之间的相关性。 该单中心病例对照研究对2008～2017年5月韩国首尔大学医院江南体检中心参加健康体检的志愿者同时进行乳房钼靶检查、乳房和肝脏超声检查，将确诊乳腺癌患者与无乳腺癌对照者按1∶1的比例进行匹配，通过条件逻辑回归进行分析。 结果，确诊乳腺癌患者、无乳腺癌对照者各270例，其中非酒精脂肪肝患者分别为81例、54例（30.0%比20.0%，P=0.008）。 多因素分析表明，有、无非酒精脂肪肝相比，乳腺癌发生率高1.63倍（95%置信区间：1.01～2.62，P=0.046）。 当分析体重指数对非酒精脂肪肝与乳腺癌相关性的影响时，发现体重指数<25显著增强非酒精脂肪肝与乳腺癌的相关性（P=0.021）。 亚组分析表明，有、无非酒精脂肪肝相比：
因此，该单中心病例对照研究结果表明，非酒精脂肪肝与乳腺癌显著相关，且不受传统风险因素影响，该相关性仅存在于非肥胖亚组，而不存在于肥胖亚组，反映了非肥胖女性的非酒精脂肪肝与乳腺癌可能存在共同发病基础。 不过，该研究仅仅通过超声检查而非病理检查确诊非酒精脂肪肝，而且病例数量较少，并且故有必要进一步开展大规模研究进行验证。 Dig Liver Dis. 2019 Jan 9. [Epub ahead of print] Nonalcoholic fatty liver disease is associated with breast cancer in nonobese women. Min-Sun Kwak, Jeong Yoon Yim, Ann Yi, Goh-Eun Chung, Jong In Yang, Donghee Kim, Joo Sung Kim, Dong-Young Noh. Seoul National University Hospital, Seoul, Korea; Stanford University School of Medicine, Stanford, CA, USA; Seoul National University College of Medicine, Seoul, Korea. BACKGROUND: Growing evidence supports that nonalcoholic fatty liver disease (NAFLD) is associated with extrahepatic cancers. Nonalcoholic fatty liver disease (NAFLD) and breast cancer share similar risk factors, including obesity. AIM: The aim of this case-control study was to investigate the association between NAFLD and breast cancer. METHODS: Subjects who received health screening, including mammography and breast and hepatic ultrasonography simultaneously, were included. Subjects diagnosed with breast cancer were matched with controls. Conditional logistic regression analyses were performed. RESULTS: Among 270 breast cancer patients and 270 controls, 81 cancer patients (30.0%) and 54 controls (20.0%) had NAFLD (P=0.008). NAFLD was significantly associated with breast cancer in multivariate analysis (P=0.046). When the interaction between obesity (BMI <25kg/m2 vs. ≥25kg/m2) and NAFLD in breast cancer patients was examined, a significant effect modification between obesity and NAFLD in breast cancer was noted (P=0.021). The subgroup analysis showed that NAFLD was significantly associated with breast cancer in the nonobese subgroup (odds ratio 3.04, 95% confidence interval 1.37-4.32, P=0.002) but not in the obese group (P=0.163). CONCLUSIONS: NAFLD was significantly associated with breast cancer independent of traditional risk factors, and this association existed in the nonobese subgroup but not in the obese subgroup. ABBREVIATIONS: NAFLD (nonalcoholic fatty liver disease), BMI (body mass index), AST (aspartate aminotransferase), ALT (alanine aminotransferase), GGT (gamma-glutamyl transpeptidase), OR (odds ratio), CI (confidence interval), IGF-1 (insulin-like growth factor-I) KEYWORDS: breast cancer, fatty liver, hepatic steatosis, obesity DOI: 10.1016/j.dld.2018.12.024
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