铁蛋白水平前瞻性地预测慢性乙型肝炎病毒感染患者的肝癌

StephenW

Oncol Lett. 2018 Sep;16(3):3499-3508. doi: 10.3892/ol.2018.9099. Epub 2018 Jul 6.
Ferritin level prospectively predicts hepatocarcinogenesis in patients with chronic hepatitis B virus infection.
Bian Z1, Hann HW2, Ye Z3, Yin C4, Wang Y1, Fang W4, Wan S5, Wang C3, Tao K1.
Author information

1
    Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China.
2
    Division of Gastroenterology and Hepatology, Department of Medicine, Liver Disease Prevention Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
3
    Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
4
    State Key Laboratory of Cancer Biology and Experimental Teaching Center of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China.
5
    Institute of Pharmacy, Pharmaceutical College of Henan University, Kaifeng, Henan 475004, P.R. China.

Abstract

Previous studies have detected a higher level of ferritin in patients with hepatocellular carcinoma (HCC), but a potential causal association between serum ferritin level and hepatocarcinogenesis remains to be clarified. Using a well-established prospective cohort and longitudinally collected serial blood samples, the association between baseline ferritin levels and HCC risk were evaluated in 1,152 patients infected with hepatitis B virus (HBV), a major risk factor for HCC. The association was assessed by Cox proportional hazards regression model using univariate and multivariate analyses and longitudinal analysis. It was demonstrated that HBV patients who developed HCC had a significantly higher baseline ferritin level than those who remained cancer-free (188.00 vs. 108.00 ng/ml, P<0.0001). The patients with a high ferritin level (≥200 ng/ml) had 2.43-fold increased risk of HCC compared to those with lower ferritin levels [hazard ratio (HR), 2.43; 95% confidence interval, 1.63-3.63]. A significant trend of increasing HRs along with elevated ferritin levels was observed (P for trend <0.0001). The association was still significant after multivariate adjustment. Incorporating ferritin into the α-fetoprotein (AFP) model significantly improved the performance of HCC prediction (the area under the curve from 0.74 to 0.77, P=0.003). Longitudinal analysis showed that the average ferritin level in HBV patients who developed HCC was persistently higher than in those who were cancer-free during follow-up. HCC risk reached a peak at approximately the fifth year after baseline ferritin detection. Moreover, stratified analyses showed that the association was noted in both males and females, and was prominent in patients with a low AFP value. In short, serum ferritin level could independently predict the risk of HBV-related HCC and may have a complementary role in AFP-based HCC diagnosis. Future studies are warranted to validate these findings and test its clinical applicability in HCC prevention and management.
KEYWORDS:

ferritin; hepatitis B virus; hepatocellular carcinoma; prospective; risk

PMID:
    30127954
PMCID:
    PMC6096080
DOI:
    10.3892/ol.2018.9099

StephenW

Oncol Lett。 2018年9月; 16（3）：3499-3508。 doi：10.3892 / ol.2018.9099。 Epub 2018年7月6日。
铁蛋白水平前瞻性地预测慢性乙型肝炎病毒感染患者的肝癌发生。
B Z1，Hann HW2，Ye Z3，Yin C4，Wang Y1，Fang W4，Wan S5，Wang C3，Tao K1。
作者信息

1
    第四军医大学西京医院肝胆外科，陕西西安710032
2
    美国宾夕法尼亚州费城托马斯杰斐逊大学医学系消化内科和肝脏病学科，19107，美国。
3
    人口科学系，肿瘤内科，Sidney Kimmel癌症中心，托马斯杰斐逊大学，费城，宾夕法尼亚州19107，美国。
4
    第四军医大学基础医学肿瘤生物学与实验教学中心国家重点实验室，陕西西安710032
五
    河南大学药学院药学研究所，河南开封475004，中国。

抽象

以前的研究已经在肝细胞癌（HCC）患者中检测到更高水平的铁蛋白，但血清铁蛋白水平与肝癌发生之间潜在的因果关系仍有待阐明。使用成熟的前瞻性队列和纵向收集的连续血液样本，在1,152名感染乙型肝炎病毒（HBV）的患者中评估基线铁蛋白水平与HCC风险之间的关联，这是HCC的主要危险因素。使用单变量和多变量分析和纵向分析，通过Cox比例风险回归模型评估关联。结果表明，发生HCC的HBV患者的基线铁蛋白水平明显高于无癌症患者（188.00 vs 108.00 ng / ml，P <0.0001）。与铁蛋白水平较低的患者相比，铁蛋白水平高（≥200ng/ ml）的患者HCC风险增加2.43倍[风险比（HR），2.43; 95％置信区间，1.63-3.63]。观察到HR增加和铁蛋白水平升高的显着趋势（趋势P <0.0001）。多变量调整后，该关联仍然显着。将铁蛋白纳入甲胎蛋白（AFP）模型显着改善了HCC预测的性能（曲线下面积从0.74到0.77，P = 0.003）。纵向分析显示，发生HCC的HBV患者的平均铁蛋白水平持续高于随访期间无癌患者。在基线铁蛋白检测后大约第五年，HCC风险达到峰值。此外，分层分析显示男性和女性都存在这种关联，并且在AFP值低的患者中显着。简而言之，血清铁蛋白水平可以独立预测HBV相关HCC的风险，并可能在基于AFP的HCC诊断中具有互补作用。未来的研究有必要验证这些发现并测试其在HCC预防和管理中的临床适用性。
关键词：

铁蛋白;乙型肝炎病毒;肝细胞癌;预期;风险

结论：
    30127954
PMCID：
    PMC6096080
DOI：
    10.3892 / ol.2018.9099

StephenW

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096080/

疯一点好

我的铁蛋白也偏高