简单模型预测HBV相关性肝硬化的不确定结节进展

StephenW

                07-02-2017 | HBV | News | Article                                            

Simple model predicts indeterminate nodule progression in HBV-related cirrhosismedwireNews: South Korean researchers have developed a risk score based on routine baseline clinical data that can assess the risk of progression to hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV)-related cirrhosis harboring indeterminate nodules.
This model could aid clinical decision making in these patients, and “could provide comprehensive and individualized medicine for each patient with HBV-related cirrhosis,” they write in The American Journal of Gastroenterology.
The team analyzed data from 356 patients, with a total of 373 indeterminate nodules revealed by dynamic liver computed tomography, where an indeterminate nodule was defined as a lesion no larger than 2 cm with undetermined malignant potential. During a median follow-up of 36 months, 16.6% of the nodules developed into HCC.
In multivariate analysis, older age, presence of arterial enhancement, history of HCC, and hepatitis B e antigen positivity were significantly linked to HCC progression, with corresponding hazard ratios (HRs) of 1.05 (per year; p=0.0033), 2.45 (p=0.001), 4.57 (p=0.006), and 2.30 (p=0.006).
Large nodule size (>1 cm), low serum albumin levels (≤3.5 g/dL), and high serum α-fetoprotein levels (≥100 ng/ml), were also identified as significant risk factors for progression to HCC, with HRs of 7.44 (p<0.001), 2.14 (p=0.024), and 4.43 (p=0.012), respectively.
Lead researcher Sung Won Cho (Ajou University School of Medicine, Suwon) and team used these parameters to develop a model that predicted the risk for HCC progression at 3 and 5 years with an accuracy of 87.9% and 92.2%, respectively. These findings were confirmed in a leave-one-out cross-validation analysis, which gave corresponding accuracy values of 88.6% and 92.0%.
Using the risk model, patients were categorized as low, intermediate, or high risk, with a cumulative incidence of HCC development at 2 years of 0%, 9.2%, and 41.6%, respectively, rising to 1.0%, 14.5%, and 63.1%, respectively, at 5 years.
Noting that the 5-year HCC progression rate in the low-risk group was not significantly greater than at 2 years, Cho et al suggest that nodular lesions in these patients “could be followed up by [a] regular surveillance schedule.”
However, they recommend an “aggressive diagnostic approach” using biopsy or magnetic resonance imaging for patients classed as high risk, among whom even the 2-year HCC progression rate was approximately 40%.
By Shreeya Nanda
medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2017

StephenW

07-02-2017 | HBV |新闻|文章
简单模型预测HBV相关性肝硬化的不确定结节进展

中国医学研究人员根据常规基线临床数据制定了风险评分，可以评估患有乙型肝炎病毒（HBV）相关性肝硬化的不确定结节患者进展为肝细胞癌（HCC）的风险。

这种模型可以帮助这些患者的临床决策，“可以为每个HBV相关性肝硬化患者提供全面和个性化的药物，”他们在“美国胃肠病学杂志”上写道。

该团队分析了来自356例患者的数据，其中动态肝脏计算机断层扫描显示总共373个不确定结节，其中不确定结节定义为具有未确定的恶性潜能的不大于2cm的损伤。在36个月的中位随访期间，16.6％的结节发展成HCC。

P = 0.0033），2.45（p≤p= 0.001），4.57（p = 0.006）和2.30（p = 0.006）。

高血清白蛋白水平（≤3.5g/ dL），高血清甲胎蛋白水平（≥100ng/ ml）也被鉴定为进展为HCC的重要危险因素，HR为7.44（p <0.001）， 2.14（p = 0.024）和4.43（p = 0.012）。

主要研究者Sung Won Cho（Ajou大学医学院，水原）和团队使用这些参数开发一个模型，预测3和5年的HCC进展的风险，分别精确度为87.9％和92.2％。在留一交叉验证分析中证实，其给出不同的精确度值88.6％和92.0％。

使用风险模型，患者被分为低，中，高风险，2年时HCC发展的累积发生率分别为0％，9.2％和41.6％，分别升至1.0％，14.5％和63.1％ ％，分别为5年。

注意到低风险组的5年HCC进展率不显着大于2年，Cho等人建议这些患者的结节性病变“可以遵循定期监测时间表。

然而，他们推荐使用活检或磁共振成像为高风险的患者的“积极诊断方法”，其中甚至2年HCC进展率约40％。

作者Shreeya Nanda

MedwireNews是由Springer Healthcare Limited提供的独立医疗新闻服务。 ©Springer Healthcare Ltd; 2017年