发病率和高加索慢性乙肝患者肝癌预测接受恩替卡韦或替诺

StephenW

Incidence and predictors of hepatocellular carcinoma in Caucasian chronic hepatitis B patients receiving entecavir or tenofovir
George V. Patheodoridis correspondence email,
George N. Dalekos,
Cihan Yurdaydin,
Maria Buti,
John Goulis,
Pauline Arends,
Vana Sypsa,
Spilios Manolakopoulos,
Giampaolo Mangia,
Nikolaos Gatselis,
Onur Keskın,
Savvoula Savvidou,
Bettina E. Hansen,
Christos Papaioannou,
Kostantinos Galanis,
Ramazan Idilman,
Massimo Colombo,
Rafael Esteban,
Harry L.A. Janssen,
Pietro Lampertico
Received: June 23, 2014; Received in revised form: August 27, 2014; Accepted: August 29, 2014; Published Online: September 05, 2014
DOI: http://dx.doi.org/10.1016/j.jhep.2014.08.045

Background & Aims

The risk of hepatocellular carcinoma (HCC) in Caucasian patients with chronic hepatitis B (CHB), treated with entecavir (ETV) or tenofovir (TDF), is unclear. We evaluated the incidence and predictors of HCC and the accuracy of existing HCC risk scores in Caucasian CHB patients receiving ETV/TDF.
Methods

This large, multicentre, retrospective cohort study included 1666 adult Caucasian CHB patients under ETV/TDF for 39 months. CHB without cirrhosis, compensated and decompensated cirrhosis were present in 67%, 39%, and 3% of patients, respectively. The predictability of baseline parameters and three risk scores (GAG-HCC, CU-HCC, and REACH-B), developed in Asian patients, was assessed.
Results

The cumulative probability of HCC was 1.3%, 3.4%, and 8.7% at year-1, year-3, and year-5 after ETV/TDF onset. Older age and lower platelets were strong independent HCC predictors in the total population and in the subgroups of cirrhotic and non-cirrhotic patients, while liver disease severity was an independent HCC predictor in the total population and in the cirrhotics. GAG-HCC, CU-HCC, and REACH-B risk scores were associated with HCC development only in the univariable but not in the multivariable analyses and offered poor to modest predictability.
Conclusions

HCC can still develop in Caucasian CHB patients treated with ETV/TDF. Besides the well-known predictors of HCC, such as older age, male gender and more advanced liver disease, lower platelets represent an independent factor of higher HCC risk. The applicability and predictability of HCC risk scores developed in Asian patients are poor or modest in Caucasian CHB patients, for whom different risk scores are required.

StephenW

发病率和高加索慢性乙肝患者肝癌预测接受恩替卡韦或替诺福韦
乔治五世Patheodoridis对应的电子邮件，
乔治·N. Dalekos，
吉汗Yurdaydin，
玛丽亚·布提，
约翰·Goulis，
宝莲ARENDS，
瓦纳Sypsa，
Spilios Manolakopoulos，
詹保罗曼吉亚，
尼可拉斯Gatselis，
厄尼尔Keskin的，
Savvoula Savvidou，
贝蒂娜E.汉森，
克里斯托帕帕约安努，
Kostantinos GALANIS，
拉马赞Idilman，
马西莫·科伦坡，
拉斐尔·埃斯特万，
哈利洛杉矶扬森，
彼得Lampertico
收稿日期：2014年6月23日;在修订后的形式收稿日期：2014年8月27日;接受：2014年8月29日;网上公布：2014年9月5日
DOI：http://dx.doi.org/10.1016/j.jhep.2014.08.045

背景与目的

肝细胞癌（HCC）的白人患者有慢性乙型肝炎（CHB），恩替卡韦（ETV）治疗或替诺福韦（TDF）的风险，目前还不清楚。我们评估的发生率和HCC的预测和现有的肝癌风险指数在高加索CHB患者接受ETV/ TDF的准确性。
方法：

这个大型，多中心，回顾性队列研究包括1666成人在ETV/ TDF的39个月白人CHB患者。 CHB无肝硬化，补偿，分别为失代偿性肝硬化存在于67％，39％和3％的患者。基线参数和三个风险评分（GAG-HCC，CU-HCC和REACH-B），在亚洲患者开发的可预测性，进行了评估。
结果

HCC的累积概率为1.3％，3.4％和8.7％，在去年1年，3年和-5后，ETV/ TDF发作。年龄和较低的血小板均较强的独立预测肝癌在总人口中的肝硬化和非肝硬化患者亚组，而肝脏疾病的严重程度是一个独立的HCC预测的总人口和肝硬化。 GAG-HCC，CU-HCC和REACH-B的风险评分均与HCC的发展只能在单变量，但不能在多变量分析，并提出穷人适度预测性。
结论

HCC仍然可以开发与ETV/ TDF治疗的白人慢性乙型肝炎患者。除了肝癌的公知的预测，如年龄，男性和更先进的肝脏疾病，降低血小板代表的较高的HCC风险的独立因素。在亚洲患者制定HCC风险评分的适用性和可预见性都在高加索CHB患者不良或温和的，对他们来说，不同的风险评分是必需的。