EASL 2018 FRI-330
Determination of the optimum timing of the start of nucleoside
analogue by FIB-4 index for hepatitis B patients from the
viewpoint of suppressing hepatocarcinogenesis
S. Hige, I. Ozeki, R. Tatsumi, M. Yamaguchi, M. Kimura, T. Arakawa,
T. Nakajima, Y. Kuwata, T. Ohmura, J. Toyota, Y. Karino. Sapporo Kosei
General Hospital, Hepatology, Sapporo, Japan
Email: [email protected]
Background and Aims: Nucleotide or nucleoside analogue (NA)
treatment to hepatitis B patients has been reported to be useful for
suppressing the occurrence of hepatocellular carcinoma (HCC).
However, not a few patients progress to HCC after the start of NA
treatment. On the other hand, early treatment initiation for young
patients should be carefully considered since the treatment may last
for a long time. Therefore, it is important to find an optimum timing
to suppress HCC occurrence effectively. In this study, we evaluated
the meaningfulness of annual average of integral FIB-4 index for
determining an adequate timing for the start of NA treatment.
Method: A total of 543 HBs antigen-positive patients who did not
have a history of HCC were followed from the start of NA
administration [entecavir (ETV) 334, lamivudine (Lam) to ETV 80,
Lam 30, Lam or ETV plus adefovir (ADV) 99 cases]. FIB-4 was
calculated by the following formula: (age [years]×AST [IU/l] / platelet
count [109/l]×ALT [IU/l]1/2). An annual average value of FIB-4 index
(FIB-4aa) which was calculated from the integral value of each FIB-4
index during the same year was used for the investigation of this
study.
Results: During an average follow-up of 5.3 years, HCCwas confirmed
in 70 patients. Overall cumulative 3/5/10 year HCC occurrence rate
was 8.4/11.2/20.7%. The cumulative 5/10 year rates of patients whose
FIB-4aa before the start of NA administration was <1.0, 1.0–2.0, 2.0–
3.0, 3.0–4.0, 4.0 ≤were 0/0, 3.6/5.2, 1.9/1.9, 16.3/32.3, 30.7/40.5%,
respectively. The expected HCC risk of those whose FIB-4aa ≥ 3.0
(high FIB-4aa group) was 10 times greater than those whose FIB-4aa
< 3.0 (low FIB-4aa group), (cumulative 5/10 year rates: 25.0/36.9 vs
2.2/3.4, p < 0.001). The cumulative 5-year risk in their 30’s/40’s/50’s/
60’s/70’swas 0/3.6/6.1/0/0% for lowFIB-4aa group and 12.5/12.0/28.2/
26.3/37.8% for high FIB-4aa group. Among FIB-4aa high group cases,
those whose FIB-4aa declined below 3.0 during NA treatment tended
to lower the risk of HCC occurrence. 5-year HCC risk of those cases
was 19.2%. The risk of those who did not show FIB-4aa decrease was
29.9% (p = 0.08).
Conclusion: FIB-4 index at the start of NA administration was highly
correlated with HCC occurrence afterwards. This tendency was the
same in any age group over 30’s. NA administration should be started
before an annual average value of integral FIB-4 index reaches 3.0. 作者: StephenW 时间: 2018-4-7 14:15