乙型肝炎e抗原血清清除后肝细胞癌和乙型肝炎表面抗原血清

StephenW

Long‐term outcomes and predictive scores for hepatocellular carcinoma and hepatitis B surface antigen seroclearance after hepatitis B e‐antigen seroclearance
James Fung
Ka‐Shing Cheung
Danny Ka‐Ho Wong
Lung‐Yi Mak
Wai‐Pan To
Wai‐Kay Seto
Ching‐Lung Lai
Man‐Fung Yuen
First published: 13 March 2018
https://doi.org/10.1002/hep.29874

Potential conflict of interest: Dr. Lai is on the speakers' bureau for and owns stock in Gilead. He is on the speakers' bureau for AbbVie. Dr. Seto advises for and is on the speakers' bureau for Gilead and Bristol‐Myers Squibb.
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Abstract

The significance of hepatitis B e‐antigen (HBeAg) seroclearance (ESC) in the long term is not well defined. The current study aimed to determine the clinical outcomes, the factors and predictive scores for hepatocellular carcinoma (HCC), and hepatitis B surface antigen (HBsAg) seroclearance of a large cohort of patients undergoing ESC. Patients with documented ESC were followed up 3‐ to 6‐monthly. Baseline characteristics and longitudinal laboratory results were recorded. Predictive scores for HCC (HCC‐ESC) and HBsAg seroclearance (HBsAg‐ESC) were derived from multivariate Cox regression models. A total of 723 patients underwent ESC with a median ESC age and follow‐up of 36.0 and 18.3 years, respectively. Only 3.5% and 3.0% had persistently normal alanine aminotransferase (ALT) and HBV DNA <2logs IU/mL, respectively, after ESC. For patients with 100%, 100%‐90%, 90%‐50%, 50%‐10%, 10%‐0%, and 0% normal ALT after HBeAg seroclearance, the rate of HCC was 4.3%, 2.2%, 3.6%, 3.9%, 17.3%, and 37.2% at 20 years after ESC, respectively (P < 0.001). At 20 years after ESC, the cumulative incidence of HCC and HBsAg seroclearance was 7.9% and 13.5%, respectively, with an overall survival of 91.5%. ESC age, male sex, cirrhosis, hypoalbuminemia, viral load, and ALT were significant factors for HCC, whereas ESC age, male sex, viral load, and antiviral therapy were significant factors for HBsAg seroclearance. The area under receiver operating characteristics for HCC‐ESC and HBsAg‐ESC scores to predict HCC and HBsAg seroclearance at 20 years after ESC was 0.92 and 0.74, respectively. Conclusion: Male sex, older age at ESC, ALT, and higher level of HBV DNA were associated with higher rates of HCC after ESC. HCC‐ESC and HBsAg‐ESC predictive scores can determine the likelihood of developing HCC and achieving HBsAg seroclearance. (Hepatology 2018)

StephenW

乙型肝炎e抗原血清清除后肝细胞癌和乙型肝炎表面抗原血清清除的长期结果和预测评分
詹姆斯冯
张嘉诚
Danny Ka-Ho Wong
龙益麦
Wai-Pan To
Wai-Kay Seto
黎庆龙
文凤媛
首次发表：2018年3月13日
https://doi.org/10.1002/hep.29874

潜在的利益冲突：Lai​​博士是Gilead的发言人并拥有股票。他是AbbVie的发言人。濑户博士为Gilead和Bristol-Myers Squibb的发言人提供咨询和建议。
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乙型肝炎e抗原（HBeAg）血清清除率（ESC）的长期意义尚不明确。目前的研究旨在确定一大群接受ESC的患者的肝细胞癌（HCC）和乙型肝炎表面抗原（HBsAg）血清清除的临床结果，因素和预测评分。记录ESC的患者随访3至6个月。记录基线特征和纵向实验室结果。 HCC（HCC-ESC）和HBsAg血清清除（HBsAg-ESC）的预测评分来自多变量Cox回归模型。共有723名患者接受ESC，ESC年龄中位数，随访时间分别为36.0和18.3岁。 ESC后，只有3.5％和3.0％的丙氨酸氨基转移酶（ALT）和HBV DNA <2logs IU / mL持续正常。对于HBeAg血清清除后100％，100％-90％，90％-50％，50％-10％，10％-0％和0％正常ALT患者，HCC发生率为4.3％，2.2％， ESC后20年分别为3.6％，3.9％，17.3％和37.2％（P <0.001）。在ESC后20年，HCC和HBsAg血清清除的累积发生率分别为7.9％和13.5％，总生存率为91.5％。 ESC年龄，男性，肝硬化，低蛋白血症，病毒载量和ALT是HCC的重要因素，而ESC年龄，男性，病毒载量和抗病毒治疗是HBsAg血清清除的重要因素。 HCC-ESC和HBsAg-ESC接受者操作特征下的面积分别预测在ESC后20年的HCC和HBsAg血清清除分别为0.92和0.74。结论：男性，ESC，ALT年龄较大，HBV DNA水平较高，与ESC后HCC发生率较高有关。 HCC-ESC和HBsAg-ESC预测评分可以确定发生HCC和实现HBsAg血清清除的可能性。 （Hepatology 2018）