老年肝B清除患者肝癌风险升高

StephenW

Elevated Liver Cancer Risk for Older Hep B-Cleared Patients

Damian McNamara

April 21, 2017

AMSTERDAM — Older people who are functionally cured of hepatitis B are at a significantly higher risk for hepatocellular carcinoma, a new study warns.

Even after the seroclearance of hepatitis B surface antigen, "there is still risk of developing hepatocellular carcinoma," particularly when clearance occurs after the age of 50, said Henry Chan, MD, director of the Institute of Digestive Disease at The Chinese University of Hong Kong.

Previous studies have demonstrated that patients in this age group who spontaneously experience seroclearance are at increased risk for hepatocellular carcinoma, he explained here at the International Liver Congress 2017. However, small cohort sizes and low event rates have limited clinical interpretation of the findings.

Confirmation of this risk could lead to closer cancer surveillance for this subgroup of patients, Dr Chan told Medscape Medical News.

Dr Chan and his colleagues assessed people with chronic hepatitis B who experienced seroclearance from January 2000 to August 2016. Mean follow-up was 3.7 years.

The team determined time of seroclearance and the subsequent development of hepatocellular carcinoma from the Clinical Data Analysis and Reporting System, a database of patients treated in Hong Kong's public healthcare system.

Of the 5181 patients identified, 3548 (69%) experienced hepatitis B surface antigen clearance after the age of 50.

In the study cohort, most of the 67 patients who developed hepatocellular carcinoma were men older than 50 years.

Table. Cumulative Incidence of Hepatocellular Carcinoma After Hep B Clearance
Subgroup                             Year 1, %     Year 3, %     Year 5, %
Young women (≤50 years)     0.2                       0.2             0.2
Young men (≤50 years)             0.5                       0.6             0.8
Older women (>50 years)     1.1                       1.3             1.3
Older men (>50 years)             1.4                       2.1             2.5

To understand why risk is higher in men who experience seroclearance after the age of 50, the researchers looked at clinical variables.

"We found, in general, that these patients tend have more advanced disease, including slightly lower albumin levels, slightly higher bilirubin levels, and slightly higher ALT levels, at a time when they are losing their antigen," Dr Chan explained. "So some of these patients probably have already suffered some liver damage before they lose S-antigen."

These data are "very good quality," and the results of this study are "reassuring," said session moderator Bruno Sangro, MD, from the Clinica Universidad de Navarra in Madrid.

"The risk of hepatocellular carcinoma is driven by the presence of cirrhosis or the presence of chronic hepatitis B infection, but that is moderated very intensely by age and gender. We know that, so this is not a surprise," he told Medscape Medical News.

"What is interesting is that there is a subpopulation of older, male patients in which the risk is greater. The practical approach is that these patients should be kept on surveillance, at least for some years," he explained.

Patients in the other risk groups should probably be followed for some time as well, but men older than 50 should be followed "for sure," Dr Sangro said.

Dr Chang and Dr Sangro have disclosed no relevant financial relationships.

International Liver Congress (ILC) 2017: Abstract PS-106. Presented April 20, 2017.

Follow Medscape Gastroenterology on Twitter @MedscapeGastro and Damian McNamara @MedReporter

StephenW

老年肝B清除患者肝癌风险升高

达米安·麦克纳马拉

2017年4月21日

AMSTERDAM - 一项新的研究警告说，功能上治愈乙型肝炎的老年人的肝细胞癌风险明显较高。

中医药大学消化系疾病研究所所长亨利·陈医生说：即使在乙型肝炎表面抗原血清清除后，仍然存在发生肝细胞癌的风险，特别是在50岁以后发生清除时，孔。

以前的研究表明，这个年龄组患者自发感染血清白血病患者肝细胞癌的风险增加，他在国际肝癌大会上就这样解释。然而，小队列大小和事件发生率低的临床解释结果有限。

陈医生告诉Medscape医学新闻，确认这一风险可能导致该亚组患者的癌症监测更为严密。

陈博士及其同事评估了二零零零年一月至二零一六年八月期间患有慢性乙型肝炎的患者，平均随访时间为3.7年。

该小组确定了临床数据分析和报告系统（一种在香港公共医疗体系中治疗的患者数据库）的血清清除时间和随后的肝细胞癌发展。

在确定的5181例患者中，3548例（69％）在50岁以后经历乙型肝炎表面抗原清除。

在研究队列中，发生肝细胞癌的67例患者中大多数是50岁以上的男性。

表。 HepB清除后肝细胞癌的累积发病率
子组1，％3，％5，％
年轻女性（≤50岁）0.2 0.2 0.2
年轻人（≤50岁）0.5 0.6 0.8
老年妇女（> 50岁）1.1 1.3 1.3
老年男子（> 50岁）1.4 2.1 2.5

为了理解为什么在50岁以后经历血清学的男性的风险更高，研究人员研究了临床变量。

陈总理解释：「我们普遍认为，这些病人往往会出现更晚期的疾病，包括白蛋白水平略有下降，胆红素水平略高，ALT水平略高。 “因此，其中一些患者在失去S-抗原之前可能已经遭受了一些肝损伤。”

这些数据是“非常好的质量”，这项研究的结果是“令人放心”，会议主持人Bruno Sangro，马德里的Navarra大学医学博士。

“肝细胞癌的风险是由于肝硬化的存在或慢性乙型肝炎感染的存在所致，但由于年龄和性别的不同，我们知道这并不奇怪，”他告诉Medscape Medical News 。

“有趣的是，有一个老年男性患者的亚群，其风险更大，实际的方法是这些患者应该被监视，至少在几年之内，”他解释说。

Sangro博士说：“其他风险群体的患者也应该遵循一段时间，但是50岁以上的男性应该遵循”肯定的“。

张博士和桑格博士没有披露任何相关的财务关系。

国际肝脏大会（ILC）2017：抽象PS-106。 2017年4月20日。

在Twitter @MedscapeGastro和Damian McNamara @MedReporter上关注Medscape Gastroenterology

newchinabok

即使在乙型肝炎表面抗原血清清除后，仍然存在发生肝细胞癌的风险

无可奈何，患乙肝就是命

tacolynn

唉，今天看到的两篇文章，一个说抗病毒了肝癌的发生率也没降低，一个是即使表抗原清除了年纪大了也会肝癌。感觉真是没活路了。。。。

StephenW

奇怪, 同样的两篇文章, 对我来说, 一个说抗病毒肝癌的发生率降低了, 另一个说早点表抗原清除, 肝癌发生率会降更低.

疯一点好

斯蒂芬这篇文章说的老年清除抗原后，肝癌不仅是照样发生而且是风险升高，那就是说超50岁后清除表面抗原比不清除的发生肝癌的风险更高，是吗？

neilhbver

不难理解，越早治疗越好。没矛盾。

StephenW

回复 疯一点好 的帖子

不是.看看这些数字:

HepB清除后, 肝细胞癌的累积发病率
组                           1年,%    3年,%   5年,%
年轻女性（≤50岁）0.2         0.2        0.2
年轻男性（≤50岁）0.5         0.6       0.8
老年女性（> 50岁）1.1        1.3        1.3
老年男性（> 50岁）1.4        2.1         2.5

如果你清除HBV, 50岁之前, 男性的5年肝癌累积发病率只有 0.8% (几乎不随着年龄增加).
相反, 50岁之后, 男性的5年累积发病率是 2.5%. 这就是他们的"老年肝B清除患者肝癌风险升高"的意思.

疯一点好

明白，谢谢斯蒂芬的解释，大于50岁组肝癌风险升高是与小于50岁组的对比而不是与非转阴的对比，看题目确实吓我一跳。