预测未接受定期监测的慢性乙型肝炎患者的早期肝细胞癌。

StephenW

Aliment Pharmacol Ther. 2018 Feb 28. doi: 10.1111/apt.14578. [Epub ahead of print]
Predictors of failure to detect early hepatocellular carcinoma in patients with chronic hepatitis B who received regular surveillance.Chon YE1,2, Jung KS3, Kim MJ4, Choi JY4, An C4, Park JY3,5, Ahn SH3,5, Kim BK3,5, Kim SU3,5, Park H1,2, Hwang SK1,2, Rim KS1,2, Han KH3,5, Kim DY3,5.
Author information
1Department of Internal Medicine, CHA Bundang Medical Center, Institute of Gastroenterology, CHA University, Seongnam, Korea.2CHA Bundang Liver Center, CHA Bundang Medical Center, Seongnam, Korea.3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.4Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.5Yonsei Liver Center, Severance Hospital, Seoul, Korea.

AbstractBACKGROUND: A proportion of chronic hepatitis B (CHB) patients are diagnosed with advanced hepatocellular carcinoma (HCC) despite regular surveillance.
AIMS: To determine predictors for HCC detection failure in CHB patients who underwent regular surveillance.
METHODS: CHB patients with well-preserved liver function, who underwent ultrasonography and alpha-foetoprotein (AFP) analysis every 6 months, were enrolled. Cox regression analysis was used to identify predictors for detection failure, defined as HCC initially diagnosed at Barcelona Clinic Liver Cancer (BCLC) stage B or C.
RESULTS: Of the 4590 CHB patients (mean age, 52.1 years; men, 61.6%), 169 patients were diagnosed with HCC (3.68%) and 35 (20.7%) HCC patients were initially diagnosed with HCC BCLC stage B or C. The cumulative incidence of HCC detection failure was 0.2% at year 1 and 1.3% at year 5. Multivariate analyses indicated that cirrhosis (hazard ratio [HR], 3.078; 95% CI, 1.389-6.821; P = 0.006), AFP levels ≥9 ng/mL (HR, 5.235; 95% CI, 2.307-11.957; P = 0.010), and diabetes mellitus (HR, 3.336; 95% CI, 1.341-8.296; P = 0.010) were independent predictors of HCC detection failure. Another model that incorporated liver stiffness (LS) values identified LS values ≥11.7 kPa (HR, 11.045; 95% CI, 2.066-59.037; P = 0.005) and AFP levels ≥9 ng/mL (HR, 4.802; 95% CI, 1.613-14.297; P = 0.005) as predictors of detection failure.
CONCLUSIONS: In CHB patients undergoing regular surveillance with ultrasonography and alpha-foetoprotein (AFP) analysis every 6 months, the HCC detection failure rate was not high (0.8% per person; 0.1% per test). However, careful attention should be paid in patients with advanced liver fibrosis (clinical cirrhosis or LS value >11.7 kPa), high AFP levels, or diabetes mellitus, who are prone to surveillance failure.

© 2018 John Wiley & Sons Ltd.

PMID:29492988DOI:10.1111/apt.14578

StephenW

Aliment Pharmacol Ther。 2018年2月28日。doi：10.1111 / apt.14578。 [电子版提前打印]
预测未接受定期监测的慢性乙型肝炎患者的早期肝细胞癌。
Chon YE1,2，Jung KS3，Kim MJ4，Choi JY4，An C4，Park JY3,5，Ahn SH3,5，Kim BK3,5，Kim SU3,5，Park H1,2，Hwang SK1,2，Rim KS1， 2，韩KH3,5，金DY3,5。
作者信息

1
    韩国城南CHA大学消化病研究所CHA盆唐医学中心内科。
2
    CHA盆唐肝脏中心，韩国城南市盆唐医​​疗中心。
3
    韩国首尔延世大学医学院内科学系。
4
    韩国首尔延世大学医学院放射科。
五
    韩国首尔Severance医院Yonsei肝脏中心。

抽象
背景：

尽管定期监测，一部分慢性乙型肝炎（CHB）患者被诊断为晚期肝细胞癌（HCC）。
目的：

确定接受定期监测的慢性乙型肝炎患者HCC检测失败的预测因子。
方法：

入选了每6个月进行超声检查和α-甲胎蛋白（AFP）分析的具有保存良好肝功能的CHB患者。使用Cox回归分析来鉴定检测失败的预测因子，定义为最初在巴塞罗那临床肝癌（BCLC）阶段B或C中诊断的HCC。
结果：

在4590例CHB患者中（平均年龄52.1岁，男性61.6％），169例确诊为HCC的患者（3.68％）和35例（20.7％）HCC患者最初被诊断为HCC BCLC B或C期。 HCC检测失败率在第1年为0.2％，第5年为1.3％。多因素分析显示，肝硬化（危险比[HR] 3.078; 95％CI 1.389-6.821; P = 0.006），AFP水平≥9ng / mL（HR，5.235; 95％CI，2.307-11.957; P = 0.010）和糖尿病（HR，3.336; 95％CI，1.341-8.296; P = 0.010）是HCC检测失败的独立预测因子。另一个纳入肝硬度（LS）值的模型确定LS值≥11.7kPa（HR，11.045; 95％CI，2.066-59.037; P = 0.005）和AFP水平≥9ng / mL（HR，4.802; 95％CI， 1.613-14.297; P = 0.005）作为检测失败的预测因子。
结论：

CHB患者每6个月进行一次超声检查和α-甲胎蛋白（AFP）分析定期监测，HCC检测失败率不高（每人0.8％;每次检测0.1％）。然而，对于易发生监测失败的晚期肝纤维化患者（临床肝硬化或LS值> 11.7 kPa），AFP水平较高或糖尿病患者应格外小心。

©2018 John Wiley＆Sons Ltd.

结论：
    29492988
DOI：
    10.1111 / apt.14578

StephenW

http://onlinelibrary.wiley.com/doi/10.1111/apt.14578/full