发生肝癌的乙肝表面抗原转阴的慢性乙肝患者后

StephenW

Incidence of hepatocellular carcinoma after HBsAg seroclearance in chronic hepatitis B patients: A need for surveillance
Gi-Ae Kim,Han Chu Lee correspondence email,
Min-Ju Kim,Yeonjung Ha,Eui Ju Park,Jihyun An,Danbi Lee,Ju yun Shim,Kang Mo Kim,Young-Suk Lim
Received: August 27, 2014; Received in revised form: November 19, 2014; Accepted: November 20, 2014; Published Online: November 28, 2014
Article has an altmetric score of 1
DOI: http://dx.doi.org/10.1016/j.jhep.2014.11.031
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Background & Aims

Little is known about whether surveillance for hepatocellular carcinoma (HCC) is worthwhile in chronic hepatitis B virus (HBV)-infected patients who have achieved HBsAg seroclearance.
Methods

A retrospective analysis of 829 patients (mean age: 52.3 years; 575 males; 98 with cirrhosis) achieving HBsAg seroclearance was performed at a tertiary hospital in Korea between 1997 and 2012. We evaluated incidence rates of HCC, and validated CU-HCC score based on data at the time of HBsAg seroclearance.
Results

During a follow-up of 3464 patient-years, 19 patients developed HCC (annual rate: 0.55%). Liver cirrhosis (hazard ratio [HR]: 10.80; 95% confidence interval [CI]: 4.25–27.43), male gender (HR: 8.96; 95% CI: 1.17–68.80), and age ⩾50 years at the time of HBsAg seroclearance (HR: 12.14; 95% CI: 1.61–91.68) were independently associated with HCC. The estimated annual incidence of HCC was 2.85% and 0.29% in patients with and without cirrhosis, respectively. Among the non-cirrhotic patients, the annual rate of HCC was higher in the male patients than in the females (0.40% vs. 0%, respectively), and all the HCCs developed after age 50. The time-dependent area under the receiver operating characteristic curves for the CU-HCC score for 5 year and 10 year HCC prediction were 0.85 and 0.74, respectively.
Conclusions

HCC surveillance should be considered for cirrhotic patients and non-cirrhotic male patients over age 50, even after HBsAg seroclearance, especially those infected with HBV genotype C. HBsAg seroclearance at age ⩾50 years was also an independent predictor for HCC.
Abbreviations:
AFP (alpha-fetoprotein), ALT (alanine aminotransferase), AUC (area under the receiver operating characteristic curve), BCLC (Barcelona Clinic Liver Cancer), CHB (chronic hepatitis B), CI (confidence interval), GGT (gamma-glutamyl transferase), HBeAg (hepatitis B e antigen), HBsAg (hepatitis B surface antigen), HBV (hepatitis B virus), HCC (hepatocellular carcinoma), HR (hazard ratio), INR (international normalized ratio), IQR (interquartile range), NUC (nucleoside analogue), ROC (receiver operating characteristics), SD (standard deviation)

StephenW

发生肝癌的乙肝表面抗原转阴的慢性乙肝患者后：一个需要监控
GI-阂金，韩楚肋锇对应的电子邮件，
闵驹金，Yeonjung哈，郑义鞠公园，Jihyun安，丹陛李某，鞠云沉康默金，英淑林
收稿日期：2014年8月27日;收到修订表格：2014年11月19日;接受：二零一四年十一月二十○日;网上公布：2014年11月28日
第二十有altmetric比分1
DOI：http://dx.doi.org/10.1016/j.jhep.2014.11.031
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背景与目的

鲜为人知的是，监控肝细胞癌（HCC）是否值得在慢性乙型肝炎病毒（HBV）感染的谁取得了乙肝表面抗原转阴的患者。
方法：

829例患者进行回顾性分析（平均年龄：52.3年; 575男性; 98肝硬化）实现在三级医院在韩国1997年和2012年之间，我们评估肝癌的发病率进行乙肝表面抗原转阴，并验证CU-HCC基于评分关于在HBsAg的血清清除的时间的数据。
结果

在后续的3464患者年，19例患者发生HCC（年利率：0.55％）。肝硬化（危险比[HR]：10.80; 95％置信区间[CI]：4.25-27.43），男性（HR：8.96; 95％CI：1.17-68.80），和年龄⩾50年在HBsAg的时间血清学清除（HR：12.14; 95％CI：1.61-91.68）是独立与肝癌有关。 HCC估计年发病率为2.85％，并在患者和无肝硬化，分别为0.29％。间的非肝硬化患者中，肝癌的年率为男性患者比在女性更高（0.40％对0％，分别），和所有的接收器根据50岁以后开发的与时间相关的区域中的肝细胞癌工作特性曲线的CU-HCC得分5年年和10年HCC预测分别为0.85和0.74，分别。
结论

HCC监测应考虑肝硬化患者和非肝硬化患者男性50岁以上，即使乙肝表面抗原血清学清除，尤其是那些在年龄感染HBV基因型C.乙肝表面抗原血清学清除⩾50年也是一个独立的预测肝癌。
缩写：
AFP（甲胎蛋白），ALT（丙氨酸转氨酶），AUC（受试者工作特征曲线下面积），BCLC（巴塞罗那临床肝癌），慢性乙型肝炎（慢性B型肝炎），CI（置信区间），GGT（γ-谷氨酰基转移），e抗原（乙肝e抗原），乙肝表面抗原（乙肝表面抗原），HBV（乙肝病毒），肝癌（肝癌），HR（危险比），INR（国际标准化比值），IQR（四分位距） ，NUC（核苷类似物），ROC（接收者操作特征），SD（标准偏差）