慢性乙型肝炎患者恩替卡韦或替诺福韦治疗肝癌的时间趋势

StephenW

J Viral Hepat. 2017 Nov 28. doi: 10.1111/jvh.12832. [Epub ahead of print]
Temporal Trend and Risk Determinants of Hepatocellular Carcinoma in Chronic Hepatitis B Patients on Entecavir or Tenofovir.Hsu YC1, Ho HJ2, Lee TY2,3, Huang YT4,5, Wu MS6, Lin JT1,7, Wu CY8,2,9, El-Serag HB10.
Author information
1School of Medicine and Big Data Research Center, Fu-Jen Catholic University, 2Department of Internal Medicine, Fu-Jen Catholic University Hospital New Taipei, Taiwan.2Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan.3Department of Medicine, Chung Shan Medical University, Taichung, Taiwan.4Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.5Departments of Epidemiology and Biostatistics, Brown University, RI, USA.6Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.7Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.8Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan.9School of Medicine, National Yang-Ming University, Taipei, Taiwan.10Section of Gastroenterology and Hepatology, Department of Medicine, Michael E DeBakey VA Medical Center, Baylor College of Medicine, Houston Texas, USA.

AbstractThis study aimed to elucidate the temporal change and determinants for the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B continuously receiving nucleos(t)ide analogues. Through analysis of the national healthcare database in Taiwan, we screened a total of 65,426 infected patients receiving entecavir or tenofovir for at least 3 months and excluded those with lamivudine, adefovir or telbivudine exposure, malignancy, end-stage renal failure, or a diagnosis of HCC within 3 months of starting treatment. Eligible patients (N=27,820) were followed until HCC occurrence, completion of the allowed 3-year regimen, or December 31, 2013. During a median follow-up of 25.1 (12.1-35.6) months, 802 patients developed HCC, with 1-, 2-, and 3-year cumulative incidence of 1.82% (95% CI, 1.66-1.99%), 3.05% (95% CI, 2.82-3.28%), and 4.06% (95% CI, 3.77-4.36%), respectively. HCC annual incidence decreased with an adjusted incidence rate ratio (IRR) of 0.73 (95% CI, 0.66-0.80) per yearly interval, and was associated with cirrhosis (IRR, 10.07; 95% CI, 6.00-16.90 in age <40 years; 4.69; 95% CI, 3.94-5.59 in age ≧40 years), age (IRR, 3.38; 95% CI, 2.10-5.47 for 40-50 years; 6.92; 95% CI, 4.27-11.21 for 50-60 years; 12.50; 95% CI, 7.71-20.25 for ≧60 years; <40 years as reference), male sex (IRR, 1.71; 95% CI, 1.44-2.04), HCV coinfection (IRR, 1.27; 95% CI, 1.02-1.58), and diabetes (IRR, 1.24; 95% CI, 1.05-1.45). In conclusion, the risk of HCC in patients with chronic hepatiti B receiving entecavir or tenofovir declines over time and is determined by cirrhosis, age, male sex, HCV coinfection, and diabetes. This article is protected by copyright. All rights reserved.


KEYWORDS: antiviral treatment; chronic hepatitis B; hepatocellular carcinoma; risk stratification

PMID:29193536DOI:10.1111/jvh.12832

StephenW

J病毒肝脏。 2017年11月28日doi：10.1111 / jvh.12832。 [电子版提前打印]
慢性乙型肝炎患者恩替卡韦或替诺福韦治疗肝癌的时间趋势及危险因素分析。
Hsu YC1，Ho HJ2，Lee TY2,3，Huang YT4,5，Wu MS6，Lin JT1,7，Wu CY8,2,9，El-Serag HB10。
作者信息

1
    天主教大学附属医院大数据研究中心2台湾新天主教大学附属医院内科。
2
    台中台中军区总医院消化科。
3
    台湾中山医科大学医学系。
4
    中国科学院统计科学研究所台湾台北。
五
    流行病学和生物统计学系，美国罗得岛布朗大学。
6
    台湾台北大学医学院内科。
7
    台湾高雄E-DA医院内科
8
    中国医科大学临床医学研究所台湾台中
9
    国立阳明大学医学院台湾台北
10
    美国德克萨斯州贝勒医学院Michael E DeBakey VA医学中心医学系胃肠病学和肝病学系。

抽象

本研究旨在阐明慢性乙型肝炎持续接受核苷（酸）类似物的肝细胞癌（HCC）风险的时间变化和决定因素。通过对台湾国家医疗数据库的分析，我们共筛查了65426例接受恩替卡韦或替诺福韦至少3个月的感染患者，并排除了拉米夫定，阿德福韦酯或替比夫定暴露，恶性肿瘤，终末期肾功能衰竭或诊断为HCC在3个月内开始治疗。随访符合条件的患者（N = 27,820），直到HCC发生，完成允许的3年方案或2013年12月31日。在中位随访25.1（12.1-35.6）个月期间，802名患者发生HCC，1 2年和3年累积发生率分别为1.82％（95％CI，1.66-1.99％），3.05％（95％CI，2.82-3.28％）和4.06％（95％CI，3.77-4.36％ ）， 分别。 HCC年发病率降低，每年调整发生率比率（IRR）为0.73（95％CI，0.66-0.80），与肝硬化有关（IRR 10.07; 95％CI 6.00-16.90 <40岁） ; 4.69; 95％CI，3.94-5.59，年龄≥40岁），年龄（IRR，3.38; 95％CI，2.50-5.47,40-50岁; 6.92,95％CI，4.27-11.21,50-60年; 12.50; 95％CI，≥60岁为7.71-20.25; <40年为参考），男性（IRR，1.71; 95％CI，1.44-2.04），HCV合并感染（IRR，1.27; 95％CI，1.02 -1.58）和糖尿病（IRR，1.24; 95％CI，1.05-1.45）。总之，接受恩替卡韦或替诺福韦治疗的慢性乙型肝炎患者的HCC风险随着时间的推移而下降，由肝硬化，年龄，男性，HCV合并感染和糖尿病决定。本文受版权保护。版权所有。
关键词：

抗病毒治疗;慢性乙型肝炎;肝细胞癌;风险分层

结论：
    29193536
DOI：
    10.1111 / jvh.12832

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