1057
INCIDENCE AND PREDICTIVE FACTORS OF HEPATOCELLULAR
CARCINOMA (HCC) IN A PROSPECTIVELY FOLLOWED
US COHORT OF PATIENTS AT RISK: HEPATOCELLULAR
CARCINOMA EARLY DETECTION STRATEGY (HEDS) STUDY
K Rajender Reddy1, Neehar D. Parikh2, Lewis R. Roberts3,
Myron E Schwartz4, Mindie H. Nguyen5, Alex Befeler6,
Stephanie Page-Lester7, Dale McLerran7, Sudhir Srivastava8,
Jo Ann Rinaudo9, Ziding Feng7 and Jorge A. Marrero10, (1)
University of Pennsylvania, (2)University of Michigan, (3)
Mayo Clinic Rochester, (4)Liver Cancer Program, Transplant,
Icahn School of Medicine at Mount Sinai, NY, (5)Division of
Gastroenterology and Hepatology, Stanford University, (6)
Department of Gastroenterology and Hepatology, Saint Louis
University, (7)Fred Hutchinson Cancer Research Center,
(8)Department of Medicine Division of GI, Hepatology and
Nutrition, Department of Pharmacology & Toxicology, Alcohol
Research Center, Hepatobiology & Toxicology Center,
University of Louisville, Louisville, KY, Robley Rex Louisville
VAMC, University of Louisville, (9)National Cancer Institute,
(10)University of Texas Southwestern Medical Center
Background: Worldwide, Hepatocellular carcinoma is a
common malignancy There are very few well-characterized
prospective cohorts of patients with cirrhosis assessed for
incidence and predictors of HCC The aims of this study were
to prospectively assess the incidence of HCC and determine
independent predictors of HCC in a US cohort of patients with
cirrhosis Methods: The multi-center NIH-sponsored HEDS
study of the Early Detection Research Network (EDRN)
prospectively enrolled patients at risk for HCC Enrolled
cirrhosis patients underwent standard surveillance for HCC
The database was reviewed to determine the incidence of
HCC and predictive factors of HCC Results: Participating US
Centers include University of Texas Southwestern, Stanford
University, Saint Louis University, Mayo Clinic, Mount Sinai
University Hospital, University of Michigan, and the University
of Pennsylvania; the Fred Hutchinson Cancer Research
Center in Seattle, WA, serves as the Data Management
Coordinating Center From 4/10/2013 through 12/7/2018,
1,559 patients were enrolled with median of 3 0 years’ history
of cirrhosis The majority were men (54 3%), were overweight
or obese (median body mass index [BMI] 30 1) and were
white (85 4%) 42 2% had history of HCV infection, 20 8%
had alcoholic liver disease, and 21 6% had nonalcoholic
steatohepatitis During a follow up of 3,202 person years,
there were 87 (55-BCLC early stage (0, A), 20 late stage
(B, C, D), and 12 unknown) incident cases of HCC (2 7%
incidence) In univariate analysis, baseline factors associated
with HCC were gender, obesity/BMI, age, smoking, family
history of liver cancer, CTP class, alpha fetoprotein (AFP),
albumin, AST, alkaline phosphatase, total bilirubin, INR,
MELD score, and esophageal varices In a multivariable
analysis including these predictors of HCC, effects which
were consistently significant were gender (p<0.005, male
OR=2 79; CI 1 62-4 80), age (per 5-year change, p<0 01,
OR=1.23; CI 1.06-1.42), BMI (p<0.02, [BMI ≥ 35] OR=2.32;
CI 1 04,5 16), and AFP (log(AFP), p<0 03, OR=1 45; CI
1.05-1.99); the model for these significant predictors had a
C-statistic of 0 707 Conclusion: In a prospectively followed
US cohort of cirrhosis patients at risk for HCC, the incidence
of HCC was 2 7% during a follow up of 3,202 person years
Independent and significant predictors of HCC were gender,
age, body mass index, and alpha fetoprotein.作者: StephenW 时间: 2020-11-5 09:54
1057
肝细胞的发病率和预测因素
癌变（HCC）继以下
美国高危人群：肝细胞
癌早期检测策略（HEDS）研究
K Rajender Reddy1，Neehar D. Parikh2，Lewis R. Roberts3，
Myron E Schwartz4，Mindie H.Nguyen5，Alex Befeler6，
Stephanie Page-Lester7，Dale McLerran7，Sudhir Srivastava8，
Jo Ann Rinaudo9，Ziding Feng7和Jorge A.Marrero10，（1）
宾夕法尼亚大学（2）密歇根大学（3）
梅奥诊所罗切斯特（4）肝癌计划，移植，
纽约州西奈山伊坎医学院，（5）
斯坦福大学胃肠病学和肝病学，（6）
圣路易斯胃肠病学和肝病学系
大学（7）弗雷德·哈钦森癌症研究中心，
（8）消化内科，肝内科和内科
酒精药理毒理学系营养学
研究中心，肝生物学与毒理学中心
路易斯维尔大学，肯塔基州路易斯维尔，Robley Rex路易斯维尔
VAMC，路易斯维尔大学，（9）美国国家癌症研究所，
（10）德克萨斯大学西南医学中心
背景：在世界范围内，肝细胞癌是一种
常见的恶性肿瘤很少有
评估肝硬化患者的前瞻性队列
肝癌的发病率和预测因素本研究的目的是
前瞻性评估HCC的发生率并确定
美国人群中HCC的独立预测因素
肝硬化方法：多中心NIH赞助的HEDS
早期研究网络（EDRN）的研究
前瞻性入组患者有肝癌风险
肝硬化患者接受HCC标准监测
审查数据库以确定发生率
HCC和HCC结果的预测因素：参与美国
中心包括德克萨斯大学西南斯坦福分校
大学，圣路易斯大学，梅奥诊所，西奈山
密西根大学医院和大学
宾夕法尼亚州弗雷德·哈钦森癌症研究
华盛顿州西雅图市的中心担任数据管理
协调中心从2013年4月10日至2018年7月12日，
共有1559名患者入组，中位病史为3 0年
肝硬化的大多数为男性（54 3％），超重
或肥胖（平均体重指数[BMI] 30 1），并且
白人（85 4％）42 2％曾有HCV感染史，20 8％
患有酒精性肝病，有21 6％患有非酒精性
脂肪性肝炎在3,202人年的随访中，
有87个（55-BCLC早期（0，A），20个晚期
（B，C，D）和12例未知）HCC事件案例（2 7％
发生率）在单因素分析中，基线因素与
肝癌的性别，肥胖/ BMI，年龄，吸烟，家庭
肝癌病史，CTP类，甲胎蛋白（AFP），
白蛋白，AST，碱性磷酸酶，总胆红素，INR，
MELD评分和多发性食管静脉曲张
分析，包括肝癌的这些预测因素，
性别始终具有显着性意义（p <0.005，男性
OR = 2 79; CI 1 62-4 80），年龄（每5年变化，p <0 01，
OR = 1.23； CI 1.06-1.42），BMI（p <0.02，[BMI≥35] OR = 2.32；
CI 1 04,5 16）和AFP（log（AFP），p <0 03，OR = 1 45; CI
1.05-1.99）；这些重要预测变量的模型具有
0 707的C统计量结论：在预期范围内
美国队列中的肝硬化患者有发生HCC的危险，发病率
在3,202人年的随访中，HCC的发生率为2 7％
肝癌的独立且重要的预测因素是性别，
年龄，体重指数和甲胎蛋白。