肝硬化阶段和慢性乙型肝炎患者接受抗病毒治疗的肝细胞癌

StephenW

Liver cirrhosis stages and the incidence of hepatocellular carcinoma in chronic hepatitis B patients receiving antiviral therapy
Jae-Jun Shim ORCID Icon, Chi Hyuck Oh, Jung Wook Kim, Chang Kyun Lee & Byung-Ho Kim
Pages 1029-1036 | Received 19 Apr 2017, Accepted 24 May 2017, Published online: 31 May 2017



Abstract

Objectives: Long-term antiviral therapy decreases the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB), however, it cannot eliminate the risk. We investigated the incidence of HCC at different stages of liver cirrhosis (LC) and identified clinical predictors for HCC development during antiviral therapy.

Methods: The data from 356 treatment-naïve patients aged 40 to 69 years without a history of HCC who had received entecavir for ≥6 months were collected retrospectively. The incidence of HCC was evaluated in patients with CHB only, with LC without varices (stage 1), with varices (stage 2), and with ascites (stage 3).

Results: The median follow-up period was 3.6 years. In total, 45 patients (12.6%) developed HCC. The annual incidence rates of HCC in patients with CHB only or LC in stages 1, 2, and 3 were 0.4%, 2.6%, 9.8%, and 6.7%, respectively. In multivariate analyzes, LC at stage 2 (hazard ratio [HR] 17.16, 95% confidence interval [C.I.] 3.93–75.01, p < .001), alcohol consumption (HR 3.84, 95% C.I. 1.99–7.39, p < .001), and older age (HR 1.06, 95% C.I. 1.01–1.11, p = .010) were significantly associated with HCC development. The risk decreased in those who stopped drinking after 2 years of abstinence (p = .0314).

Conclusions: LC with significant portal hypertension (varices or ascites), alcohol consumption, and older age at the time of starting antiviral therapy are independent predictors for future HCC development.
Keywords: Alcohol, antiviral therapy, chronic hepatitis B, esophageal and Gastric Varices, hepatocellular carcinoma

StephenW

肝硬化阶段和慢性乙型肝炎患者接受抗病毒治疗的肝细胞癌发病率
Jae-Jun Shim ORCID图标，Chi Hyuck喔，王荣基金，李un Lee
第1029-1036页2017年4月19日收到，2017年5月24日接受，网上发布：2017年5月31日

    下载引文http://dx.doi.org/10.1080/00365521.2017.1335773



抽象

目的：长期抗病毒治疗可降低慢性乙型肝炎（CHB）患者肝细胞癌（HCC）的风险，但无法消除风险。我们调查了肝硬化（LC）不同阶段肝癌的发病率，并确定了抗病毒治疗期间HCC发展的临床预测指标。

方法：回顾性分析356例未接受恩替卡韦≥6个月HCC史的年龄40〜69岁的未治疗患者的资料。仅在CHB患者中进行HCC的发生率，LC无静脉曲张（1期），静脉曲张（2期）和腹水（3期）评估。

结果：中位随访期为3.6年。共有45例（12.6％）发生HCC。分别为1,2和3级CHB患者或LC患者的HCC年发病率分别为0.4％，2.6％，9.8％和6.7％。在多变量分析中，第2阶段的LC（风险比[HR] 17.16,95％置信区间[CI] 3.93-75.01，p <0.001），饮酒量（HR 3.84,95％CI 1.99-7.39，p <0.001） ）和较大年龄（HR 1.06,95％CI 1.01-1.11，p = 0.010）与HCC发展显着相关。在禁食2年后停止饮酒的患者的风险降低（p = 0.0314）。

结论：开始抗病毒治疗时，具有门静脉高压（​​静脉曲张或腹水），酒精消耗和年龄较大的LC是未来HCC发展的独立预测因子。
关键词：酒精，抗病毒治疗，慢性乙型肝炎，食管和胃静脉曲张，肝细胞癌