与B型肝炎的人谁拥有肝硬化应优先用于肝癌筛查

StephenW

Hepatitis B

People with hepatitis B who have cirrhosis should be prioritised for liver cancer screening
Michael Carter
Published: 02 October 2014

Liver cancer screening for people with hepatitis B virus (HBV) infection should be targeted at those with cirrhosis, according to the results of a systematic review and meta-analysis published in PLOS ONE. The risk of hepatocellular carcinoma (HCC) and death were 31- and 44- times higher, respectively, in people with liver cirrhosis compared to people who did not have cirrhosis. Moreover, incidence among people without cirrhosis was well below the threshold of screening cost effectiveness.

“Cost of screening HBV patients without cirrhosis may outweigh the benefits,” comment the authors. “Additionally, it is important to balance potential benefits with potential harms of screening.”

Globally, tens of millions of people are living with chronic HBV infection. Its complications include HCC and an increased mortality risk. Antiviral treatment can improve outcomes, but not everyone with HBV has access to such therapy.

Guidelines recommend that everyone with HBV should be screened for liver cancer. However, it is uncertain which patients should be prioritised for screening. Screening is considered cost-effective if annual incidence is at least 0.2 per 100 person-years.

Investigators from Denmark performed a systematic review and meta-analysis of randomised controlled trials and observational studies reporting on incidence of HCC and death in people with untreated chronic HBV infection.

A total of 68 studies met their inclusion criteria; 49 were randomised controlled trials, the remainder case-controlled studies. A total of 27,584 people were enrolled in these studies, and they provided approximately 265,000 person-years of follow-up. The median duration of follow-up was two years.

The quality of studies was evaluated as high.

Data on incidence of HCC were reported in 57 studies. The cancer was diagnosed in 1285 of 26,687 people (5%). Annual incidence was 0.88 per 100 person-years (95% CI, 0.76-0.99).

Almost a quarter of people with cirrhosis (23%) developed HCC compared to 1% of people who did not have cirrhosis. Incidence of liver cancer among people with cirrhosis was 3.16 per 100 person-years (95% CI, 2.58-3.74), some 31-fold higher than the incidence in people without cirrhosis (0.10 per 100 person-years; 95% CI, 0.02-0.18). Co-infection with hepatitis C virus, older age and elevations in liver enzymes were also associated with increased HCC risk.

Mortality was reported in 30 studies. A total of 730 of 12,511 patients (6%) died. The overall mortality incidence was 1.26 per 100 person-years (95% CI, 1.01-1.51). Over a quarter (28%) of people with cirrhosis died, compared to 2% of people who did not have cirrhosis.

The mortality incidence among people with HCC was 4.89 per 100 person-years (95% CI, 3.16-6.63), which was 44-fold higher than that seen in people without cirrhosis (0.11 per 100 person-years; 95% CI, 0.09-0.14).

Screening for HCC had no influence on mortality.

“The combined evidence stresses the importance of risk stratification in HBV,” conclude the authors. “In non-cirrhotic patients without inflammatory activity HCC screening could be futile due to the low incidence, whereas efforts should be made to detect HCC in at-risk patients with cirrhosis, HCV coinfection, old age and inflammatory activity.”
Reference

Thiele M et al. Large variations in risk of hepatocellular carcinoma and mortality in treatment naïve hepatitis B patients: systematic review with meta-analysis. PLOS ONE, 9(9): e107177, 2014.

StephenW

乙肝

与B型肝炎的人谁拥有肝硬化应优先用于肝癌筛查
迈克尔·卡特
发布时间：2014年10月2日

肝癌筛查患有B型肝炎病毒（HBV）感染，应针对那些有肝硬化，根据公布在PLoS ONE的系统回顾和荟萃分析的结果。肝细胞癌（HCC）和死亡的风险分别为31-2和44-1倍，分别患有肝硬化相比，谁没有肝硬化的人。此外，人无肝硬化中发生率远低于筛选成本效益的门槛。

“筛查乙肝病人没有肝硬化的成本可能得不偿失，”评论的作者。 “此外，它平衡了筛查的潜在危害潜在的好处是非常重要的。”

全球范围内，数以千万计的人患有慢性HBV感染。其并发症包括肝癌和死亡风险增加了。抗病毒治疗可改善预后，但不是每个人乙肝病毒具有获得这种治疗。

指南建议，每个人都与乙肝应筛查肝癌。然而，目前尚不能确定哪些病人应优先进行筛选。筛查被认为是符合成本效益的，如果每年的发病率是每100人 - 年至少0.2。

来自丹麦的研究人员进行了系统回顾和荟萃分析的随机对照试验和观察性研究对肝癌的发病率和死亡率在人与未经治疗的慢性HBV感染者的报告。

共有68项研究符合其纳入标准; 49，随机对照试验，其余病例对照研究。共有27584人报名参加这些研究中，他们提供了大约265,000人 - 年的随访。随访时间中位数为两年。

研究的质量被评估为高。

对肝癌的发病率数据分别报告了57件。癌症被诊断出128526687人（5％）。每年的发病率为0.88每100人年（95％CI，0.76-0.99）。

几乎有四分之一的人患有肝硬化（23％）开发的肝癌相比，谁没有肝硬化的人1％。患有肝硬化中肝癌的发病率是3.16每100人年（95％CI，2.58-3.74），约31倍，比发生在人们没有肝硬化较高（0.10每100人年，95％CI，0.02 -0.18）。共感染了丙型肝炎病毒，年龄和肝酶升高也具有增加的肝细胞癌的风险相关联。

死亡报告了30项研究。共有73012,511例（6％）死亡。总的死亡率发生率为1.26每100人年（95％CI，1.01-1.51）。超过四分之一的人患有肝硬化（28％）死亡，相比之下，谁没有肝硬化的人2％。

死亡率发病人肝癌中是4.89每100人年（95％CI，3.16-6.63），这是44倍，比无肝硬化（0.11每100人年看到人高，95％CI，0.09 -0.14）。

筛查肝癌对死亡率没有影响。

“合并后的证据，强调危险分层的重要性，乙肝病毒”，作者总结。 “在非肝硬化患者无炎症活动肝癌筛查可能是徒劳的，由于发病率低，而应该努力来检测肝癌的高风险患者的肝硬化，丙肝合并感染，老年和炎症活动。”
参考

Thiele型M等。大的变化，肝癌和死亡的风险在初次接受治疗的乙肝患者：与荟萃分析系统的审查。 PLOS ONE，9（9）：e107177，2014年。