Revised Korean Antiviral Guideline Reduces the Hepatitis B-related Hepatocellular Carcinoma Risk in Cirrhotic Patients
David Sooik Kim # 1 , Soo Young Park # 2 , Beom Kyung Kim 1 3 , Jun Yong Park 1 3 , Do Young Kim 1 3 , Kwang Hyub Han 1 3 , Yu Rim Lee 2 , Won Young Tak 2 , Young Oh Kweon 2 , Inkyung Jung 4 , Minkyung Han 5 , Eun Hwa Kim 5 , Sang Hoon Ahn 1 3 , Seung Up Kim 1 6
Affiliations
PMID: 33904261 DOI: 10.3346/jkms.2021.36.e105
Abstract
Background: Since September 2015, the initiation of antiviral therapy (AVT) for patients with chronic hepatitis B (CHB)-related cirrhosis has been reimbursed according to the revised Korean Association for the Study of Liver (KASL) guideline, if the patient had hepatitis B virus DNA level ≥ 2,000 IU/L, regardless of aminotransferase or alanine aminotransferase levels. This study investigated whether the KASL guideline implementation reduced the risk of CHB-related hepatocellular carcinoma (HCC) in patients with cirrhosis in South Korea.
Methods: A total of 429 patients with CHB-related cirrhosis who initiated AVT between 2014 and 2016 were recruited. The risk of HCC development was compared between patients who initiated AVT before and after September 2015 (pre-guideline [n = 196, 45.7%] vs. post-guideline implementation [n = 233, 54.3%]).
Results: Univariate analysis showed that AVT initiation before guideline implementation, older age, male gender, and diabetes significantly predicted increased risk of HCC development (all P < 0.05). Subsequent multivariate analysis showed that AVT initiation before guideline implementation (HR = 1.941), older age (HR = 5.762), male gender (HR = 2.555), and diabetes (HR = 1.568) independently predicted increased risk of HCC development (all P < 0.05). Additionally, multivariate analysis showed that AVT initiation before guideline implementation (HR = 2.309), male gender (HR = 3.058), and lower platelet count (HR = 0.989) independently predicted mortality (P < 0.05). The cumulative incidences of HCC and mortality were significantly higher in patients who initiated AVT before guideline implementation than in those who initiated AVT after guideline implementation (all P < 0.05, log-rank test).
Conclusion: The prognosis of patients with CHB-related cirrhosis who initiated AVT improved after guideline implementation according to the revised KASL guideline.
修订后的韩国抗病毒指南降低了肝硬化患者乙型肝炎相关的肝细胞癌的风险
David Sooik Kim 1,Soo Young Park 2,Beom Kyung Kim 1 3,Jun Yong Park 1 3,Do Young Kim 1 3,Kwang Hyub Han 1 3,Yur Rim Lee 2,Won Young Tak 2,Young Oh Kweon 2 ,Inkyung Jung 4,Minkyung Han 5,Eun Hwa Kim 5,Sang Hoon Ahn 1 3,Seung Up Kim 1 6
隶属关系
PMID:33904261 DOI:10.3346 / jkms.2021.36.e105
抽象的
背景:自2015年9月起,根据修订后的韩国肝病研究协会(KASL)指南,如果慢性乙型肝炎(CHB)相关性肝硬化患者已开始抗病毒治疗(AVT),如果该患者患有肝炎,该费用已报销无论氨基转移酶或丙氨酸氨基转移酶水平如何,乙型病毒DNA≥2,000 IU / L。这项研究调查了KASL指南的实施是否降低了韩国肝硬化患者CHB相关性肝细胞癌(HCC)的风险。