AASLD2014:肝癌治疗慢性乙型肝炎患者的长期处理 - 恩替卡韦的

StephenW

1870Incidence of Hepatocellular Carcinoma in a National Cohort of Chronic Hepatitis B Patients on Long Term Entecavir Treatment- the ENUMERATE studyJoseph Ahn1, Joseph K. Lim2, Hannah Lee3, Calvin Q. Pan4, Mindie H. Nguyen5, Huy N. Trinh6, Tram T. Tran7, Danny Chu8, Albert Min9, Son T. Do10, Jocelyn Woog11, Ajitha Mannalithara5, Anna S. Lok12, W. Ray Kim5;1OHSU, Portland, OR; 2Yale University, New Haven, CT; 3Tufts Medical Center, Boston, MA; 4NYU Langone, New York City, NY; 5Stanford University, Stanford, CA; 6San Jose Gastroenterology, San Jose, CA; 7Cedars-Sinai, Los Angeles, CA; 8Albert Einstein College of Medicine, New York City, NY; 9Mount Sinai Beth Israel, New York City, NY; 10Digestive Health Associates of Texas, Plano, TX; 11Asian Health Foundation, Rochester, MN; 12University of Michigan, Ann Arbor, MIBackground- Antiviral therapy for chronic hepatitis B (HBV) has been associated with decreased risk of hepatocellular carcinoma (HCC). However, the risk of HCC persists even after many years of antiviral therapy. Aim- To determine HCC incidence in patients receiving long-term entecavir (ETV) treatment in “real-life” practice settings in the United States (US). Methods-The ENUMERATE study was conducted in a national network of 26 academic and private liver centers in the US, in partnership with the AHF. Treatment-naTve HBV-infected patients ≥ 18 years old and without a history of HCC who had received ETV for ≥ 12 months between 2005 and 2013 were included. HCC diagnosis was based on AASLD criteria. Kaplan-Meier methods were used to estimate HCC incidence. Results- Of 841 patients, 745 [63% men, 83% Asians, 26% HBeAg+, 9.3% cirrhosis; median age 47 years (18-83)] met the inclusion criteria. During a median follow-up of 4 (1-8.3) years, 26 patients developed HCC, including 8 who developed HCC during the first 12 months of ETV therapy. HCC incidence at 5 years was 2% in non-cirrhotics and 14% in cirrhotics. Patients who developed HCC were older (53.4 vs. 46.8 years) and more likely to have cirrhosis (39% vs. 8%) than those who did not develop HCC. There were no statistically significant differences in HCC incidence by gender, ethnicity, baseline HBV DNA, ALT, or HBeAg status. Conclusion- Patients with HBV infection receiving ETV remained at risk for HCC, especially if they were older or had cirrhosis. Continued HCC surveillance remains warranted in patients on antiviral therapy.

Disclosures:
Joseph Ahn - Advisory Committees or Review Panels: gilead; Grant/Research Support: bms
Joseph K. Lim - Consulting: Merck, Vertex, Gilead, Bristol Myers Squibb, Boeh-ringer-Ingelheim; Grant/Research Support: Abbott, Boehringer-Ingelheim, Bristol Myers Squibb, Genentech, Gilead, Janssen/Tibotec, Vertex, Achillion
Hannah Lee - Grant/Research Support: BMS
Calvin Q. Pan - Advisory Committees or Review Panels: BMS, Gilead; Consulting: BMS, Gilead, Merck, Abbvie, Janssen ; Grant/Research Support: BMS, Gilead, Genentech, Merck; Speaking and Teaching: BMS, Gilead, Onyx
Mindie H. Nguyen - Advisory Committees or Review Panels: Bristol-Myers Squibb, Bayer ΔG, Gilead, Novartis, Onyx; Consulting: Gilead Sciences, Inc.; Grant/Research Support: Gilead Sciences, Inc., Bristol-Myers Squibb, Novartis Pharmaceuticals, Roche Pharma ΔG, Idenix, Hologic, ISIS
Huy N. Trinh - Advisory Committees or Review Panels: BMS, Gilead; Grant/ Research Support: BMS, Gilead; Speaking and Teaching: BMS, Gilead, vertex; Stock Shareholder: Gilead
Tram T. Tran - Advisory Committees or Review Panels: Gilead, Bristol Myers Squibb; Consulting: Gilead, AbbVie, Janssen; Grant/Research Support: Bristol Myers Squibb; Speaking and Teaching: Bristol Myers Squibb, Gilead
Danny Chu - Consulting: Gilead, Gilead, Gilead, Gilead; Speaking and Teaching: Gilead, Gilead, Gilead, Gilead
Albert Min - Consulting: Bristol Myers Squibb, Gilead, Janssen; Grant/Research Support: Bristol Myers Squibb, Gilead; Speaking and Teaching: Bristol Myers Squibb, Gilead
Son T. Do - Advisory Committees or Review Panels: gilead, Asian Health Foundation, gilead, Asian Health Foundation, gilead, Asian Health Foundation, gilead, Asian Health Foundation; Speaking and Teaching: bms, gilead, Asian Health Foundation, bms, gilead, Asian Health Foundation, bms, gilead, Asian Health Foundation, bms, gilead, Asian Health Foundation
Anna S. Lok - Advisory Committees or Review Panels: Gilead, Immune Targeting System, MedImmune, Arrowhead, Bayer, GSK, Janssen, Novartis, ISIS, Tekmira; Grant/Research Support: Abbott, BMS, Gilead, Merck, Roche, Boehringer
W. Ray Kim - Consulting: Bristol Myers Squibb, Gilead Sciences
The following people have nothing to disclose: Jocelyn Woog, Ajitha Manna-lithara

StephenW

1870
肝癌治疗慢性乙型肝炎患者的长期处理 - 恩替卡韦的研究列举了国家队列发病率
约瑟夫Ahn1，约瑟夫·K。LIM2，汉娜Lee3，卡尔文问：Pan4，Mindie阁下Nguyen5，伊北Trinh6，电车吨Tran7，丹尼Chu8，阿尔伯特Min9，儿子吨DO10，乔斯林Woog11，Ajitha Mannalithara5，安娜Š 。Lok12，W·雷Kim5;
1OHSU，波特兰，俄勒冈; 2Yale大学，纽黑文，CT; 3Tufts医学中心，波士顿，MA; 4NYU朗格尼，纽约市，纽约州; 5Stanford大学，斯坦福大学，加州; 6San何塞消化内科，圣何塞，加利福尼亚; 7Cedars - 西奈，洛杉矶，加州; 8Albert爱因斯坦医学院，纽约市，纽约州; 9Mount西奈贝斯以色列，纽约市，纽约州;德克萨斯州普莱诺，德克萨斯州10Digestive卫生协会; 11Asian健康基金会，明尼苏达州罗切斯特; 12University密歇根州，密歇根州安阿伯

背景 - 抗病毒治疗慢性乙型肝炎病毒（HBV）已与肝细胞癌（HCC）的风险降低。但是，肝癌的危险性，即使经过多年的抗病毒治疗仍然存在。 Aim-要确定肝癌发生率在美国（美国）“现实生活”的做法设置长期接受恩替卡韦（ETV）治疗的患者。方法，将列举研究在美国26学术界和私营肝病中心的全国网络进行的，与AHF的合作伙伴关系。治疗naTve HBV感染患者≥18岁，没有接受过教育电视于2005年至2013年间≥12个月被列入谁肝癌的历史。肝癌的诊断是基于AASLD标准。的Kaplan-Meier方法来估计的HCC发病率。结果 - 841例，745[63％为男性，83％的亚洲人，26％的HBeAg+，9.3％肝硬化;平均年龄47岁（18-83）符合纳入标准。在平均随访4（1-8.3岁），26例患者发生肝癌，其中包括8谁在恩替卡韦治疗的头12个月开发的肝癌。肝癌发病率5年为2％，非肝硬化及肝硬化14％。谁开发的HCC患者年龄较大（53.4对比46.8年），更可能有肝硬化（39％比8％）​​比那些谁没有发展肝癌。有按性别，种族，基线HBV DNA，ALT或HBeAg状态在肝癌发生率无统计学差异显著。结论 - 患者HBV感染接受教育电视仍处于危险肝癌，特别是如果他们是老年人或患有肝硬化。继续肝癌监测仍然保证患者的抗病毒治疗。
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披露：

约瑟夫·安 - 咨询委员会或审查小组：基列;格兰特/研究支援：BMS

约瑟夫·K.林 - 咨询：默克，顶点，基列，施贵宝公司，Boeh-铃声殷格翰;格兰特/研究支持：雅培，勃林格殷格翰，施贵宝公司，基因泰克，Gilead公司，扬森/ Tibotec公司，顶点，艾琪尔顿

汉娜李 - 格兰特/研究支持：BMS

卡尔文问：泛 - 咨询委员会或审查小组：BMS，基列;咨询：BMS，Gilead公司，默克公司，Abbvie，扬森;格兰特/研究支持：BMS，Gilead公司，基因泰克，默沙东;口语和教学：BMS，基列，玛瑙

Mindie H.阮 - 咨询委员会或审查小组：百时美施贵宝，拜耳ΔG，Gilead公司，诺华公司，玛瑙;咨询：吉利德科学公司;格兰特/研究支持：吉利德科学公司，施贵宝，诺华制药，罗氏制药ΔG，Idenix公司，Hologic公司，ISIS

伊北郑氏 - 咨询委员会或审查小组：BMS，基列;格兰特/研究支持：BMS，基列;口语和教学：BMS，基列，顶点;股股东：吉利德

电车T.陈德良 - 咨询委员会或审查小组：Gilead公司，施贵宝公司;咨询：基列，AbbVie，扬森;格兰特/研究支援：施贵宝公司;口语和教学：施贵宝公司，吉利德

朱丹尼 - 咨询：基列，基列，基列，基列;口语和教学：Gilead公司，Gilead公司，Gilead公司，吉利德

阿尔伯特最小 - 咨询：施贵宝公司，Gilead公司，扬森;格兰特/研究支援：施贵宝公司，Gilead公司;口语和教学：施贵宝公司，吉利德

儿子T.执行 - 咨询委员会或审查小组：Gilead公司，亚洲健康基金会，基列，亚洲健康基金会，基列，亚洲健康基金会，基列，亚洲健康基金会;口语和教学：BMS，基列，亚洲健康基金会，拜耳，基列，亚洲健康基金会，拜耳，基列，亚洲健康基金会，拜耳，基列，亚洲健康基金会

安娜南乐 - 咨询委员会或审查小组：基列，免疫瞄准系统，MedImmune公司，慈姑，拜耳，葛兰素史克，西安杨森，诺华，ISIS，Tekmira;格兰特/研究支持：雅培，拜耳，基列，默克，罗氏，勃林格

W·雷金 - 咨询：施贵宝公司，Gilead科学

下面的人都没有透露：乔斯林Woog，Ajitha甘露，lithara