THU-214
Annual average of integral FIB-4 index and HBV core-related
Antigen as an appropriate indicators for starting nucleoside
Analogs at an optimum timing
Shuhei Hige1, Itaru Ozeki1, Hirokazu Suii1, Ryoji Tatsumi1,
Masakatsu Yamaguchi1, Mutsuumi Kimura1, Tomohiro Arakawa1,
Tomoaki Nakajima1, Yasuaki Kuwata1, Takumi Ohmura1, Joji Toyota1,
Yoshiyasu Karino1. 1Sapporo-Kosei General Hospital, Hepatology,
Sapporo,
Email: [email protected]
Background and aims: Although nucleos (t)ide analogue (NA) has
Reported to be useful for suppressing hepatocellular carcinoma
(HCC) with hepatitis B patients, it is important not to miss an
Optimum timing of starting NA because not a few patients progress to
HCC later. Serum HBV core-related antigen (HBcrAg) is reported
To correlate with intrahepatic cccDNA which may be related to viral
Activity and carcinogenic risk. In this study,
Average of integral FIB-4 index (aaFIB-4) and serum HBcrAg for
Determine an adequate timing of NA and estimating the HCC risk
During NA treatment.
Method: A total of 522 HBs antigen (HBsAg)-positive patients who
Did not have a history of HCC were followed from the start of NA
[entecavir (ETV) 319, lamivudine (Lam) to ETV 76, Lam 28, Lam or ETV
Plus adefovir (ADV) 99 cases]. An aaFIB-4 was calculated from
The integral value of each FIB-4 index during the same year. Serum
Levels of HBcrAg were measured by the LumipulseR HBcrAg Chemiluminescence Enzyme Immunoassay (Fujirebio, Tokyo, Japan).
The dynamic range of the assay is 3.0 to 6.8 (log10 U/ml). Kaplan-
Meier method was used to estimate the cumulative occurrence of
HCC.
Results: During the median follow-up of 107 months, HCC was
Confirmed in 79 patients. Overall cumulative 5/10 year occurrence
Rate of HCC (5/10y-HCC rate) was 10.0/18.2%. The cut off value of
aaFIB-4 and log10 HBsAg at the start of NA treatment for the
Occurrence of HCC during the treatment course was 3.00 and 3.2
(log10 IU/ml) by ROC analysis. 5y-HCC rate was 0/2.3/1.1/18.7/31.3 (%)
For those whose pretreatment aaFIB-4 was <1.0/1.0-2.0/2.0-3.0/3.0-
4.0/4.0 ≤ and 5.1/15.9/5.7 (%) for those whose pretreatment HBcrAg
Was <3.0/3.0-6.8/6.8 < .5/10y-HCC rate by the combined conditions is
Shown in Table. High aaFIB-4 was a significant predictive factor of
HCC and high HBsAg/low HBcrAg indicated low risk of HCC.
Of high aaFIB-4/low HBsAg, probability of HCC increased with
Increasing HBcrAg. 10y-HCC rate of cases↻ HBcrAg residual
<3.0 (Gr.1), decreased to <3.0 (Gr.2), remained ≥3.0 (Gr.3) was 5.1/
11.9/17.8 (%). Among high aa FIB-4 cases, 5y-HCC risk of those whose
Aa FIB-4 declined below3.00 during NA treatment was 17.2%,
Those who did not showaaFIB-4 decrease was 29.5% (p = 0.04).
Table: 5y/10y-HCC rate (%) by the combined conditions of aaFIB-4
Index, HBcrAg and HBsAg.
Overall aaFIB-4 <3.00 aaFIB-4 ≥3.00
log10HBsAg <3.2 3.2 ≤ , <3.2 3.2 ≤ , <3.2 3.2 ≤
HBcrAg <3.0 8.4/8.4 2.3/2.3 , 0/0 0/0 ,19.0/19.0 0/0
3.0–6.8 17.6/30.2 11.9/19.6 ,5.0/14.7 2.4/5.1 , 22.9/48.0 24.6/39.2
6.8 < 10.3/17.6 1.4/8.6 0/0 ,0/3.5 27.3/62.7 ,17.6/21.6
Conclusion: AaFIB-4 and HBcrAg at the start of NA treatment was
Corroded with occurrence of HCC afterwards. NA should be started
Before aaFIB-4 index reaches 3.00. The decrease of aaFIB-4 or HBcrAg
After NA treatment may reduce the risk of HCC.
Conclusion: AaFIB-4 and HBcrAg at the start of NA treatment was
Corroded with occurrence of HCC afterwards. NA should be started
Before aaFIB-4 index reaches 3.00. The decrease of aaFIB-4 or HBcrAg
After NA treatment may reduce the risk of HCC.作者: StephenW 时间: 2019-4-4 13:05