接受恩替卡韦/替诺福韦的初治慢性乙型肝炎患者肝细胞癌风

StephenW

Eur J Gastroenterol Hepatol. 2019 Jan 28. doi: 10.1097/MEG.0000000000001357. [Epub ahead of print]
Prediction model for hepatocellular carcinoma risk in treatment-naive chronic hepatitis B patients receiving entecavir/tenofovir.
Yu JH1, Suh YJ2, Jin YJ1, Heo NY3, Jang JW4, You CR5, An HY6, Lee JW1.
Author information

1
    Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine.
2
    Department of Biomedical Sciences, College of Medicine, Inha University, Incheon.
3
    Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan.
4
    Department of Internal Medicine, Eulji University Hospital, Daejeon.
5
    Department of Internal Medicine, Saint Paul's Hospital, Catholic University of Korea.
6
    Departments of Biostatistics, College of Medicine, Korea University, Seoul, South Korea.

Abstract
BACKGROUND/AIM:

Accurate assessment of hepatocellular carcinoma (HCC) risk in chronic hepatitis B (CHB) patients receiving entecavir (ETV)/tenofovir disoproxil fumarate (TDF) is likely to play a pivotal role in post-treatment follow-up strategy. We aimed to develop a simple and reliable predictive model for HCC risk in these patients.
PATIENTS AND METHODS:

A database of 1242 consecutive treatment-naive CHB patients who initially underwent ETV/TDF between February 2007 and January 2017 at four referral hospitals in South Korea was analyzed. The HCC risk model was constructed on the basis of a multivariable Cox proportional hazards model in the derivation dataset (n=944) and was validated using Harrell's C-statistic in a validation dataset (n=298).
RESULTS:

The 3/5-year cumulative incidence rates of HCC were 3.9/6.5 and 4.2/11.6% in the derivation and the validation dataset, respectively (P=0.08). In the derivation dataset, we identified four factors associated with HCC, namely, age, albumin, sex, and liver cirrhosis. The AASL (age, albumin, sex, liver cirrhosis)-HCC scoring system was developed on the basis of these factors, and simplified to an integer scoring system. AASL-HCC scores were found to have high discriminating performance for the prediction of HCC development at 5 years in the derivation (C-statistics=0.802, 95% confidence interval: 0.716-0.888) and validation dataset (C-statistics=0.805, 95% confidence interval: 0.671-0.939). When AASL-HCC scores were classified as 5 or less, 6-19, and at least 20 (low-risk, intermediate-risk, and high-risk groups, respectively), the 5-year cumulative incidence rates of HCC were 0, 4.2, and 17.6%, respectively, in the derivation dataset.
CONCLUSIONS:

The AASL-HCC model was simple and reliable for HCC risk prediction in treatment-naive CHB patients receiving ETV/TDF, and is easily applicable in the clinical setting.

PMID:
    30694912
DOI:
    10.1097/MEG.0000000000001357

StephenW

Eur J Gastroenterol Hepatol。 2019年1月28日doi：10.1097 / MEG.0000000000001357。 [印刷前的电子版]
接受恩替卡韦/替诺福韦的初治慢性乙型肝炎患者肝细胞癌风险预测模型。
Yu JH1，Suh YJ2，Jin YJ1，Heo NY3，Jang JW4，You CR5，An HY6，Lee JW1。
作者信息

1
    仁荷大学医学院仁荷大学医院内科。
2
    仁川仁荷大学医学院生物医学科学系。
3
    釜山海都大白医院Inje大学内科。
4
    大田市Eulji大学医院内科。
五
    韩国天主教大学圣保罗医院内科。
6
    韩国首尔医学院生物统计学系，韩国首尔。

抽象
背景/目的：

准确评估接受恩替卡韦（ETV）/替诺福韦地索普西富马酸盐（TDF）的慢性乙型肝炎（CHB）患者的肝细胞癌（HCC）风险可能在治疗后随访策略中起关键作用。我们的目标是为这些患者开发一种简单可靠的HCC风险预测模型。
患者和方法：

在2007年2月至2017年1月期间，在韩国的四家转诊医院分析了最初接受ETV / TDF治疗的1242例初治CHB患者的数据库。 HCC风险模型是在衍生数据集（n = 944）中基于多变量Cox比例风险模型构建的，并且在验证数据集（n = 298）中使用Harrell的C统计量进行验证。
结果：

在推导和验证数据集中，HCC的3/5年累积发生率分别为3.9 / 6.5和4.2 / 11.6％（P = 0.08）。在推导数据集中，我们确定了与HCC相关的四个因素，即年龄，白蛋白，性别和肝硬化。 AASL（年龄，白蛋白，性别，肝硬化）-HCC评分系统是在这些因素的基础上发展起来的，并简化为整数评分系统。发现AASL-HCC评分具有较高的鉴别性能，可用于预测5年内HCC发展的推导（C-统计= 0.802,95％可信区间：0.716-0.888）和验证数据集（C-统计= 0.805,95） ％置信区间：0.671-0.939）。当AASL-HCC评分分为5分或更低，6-19分和至少20分（低风险，中等风险和高风险组）时，HCC的5年累积发病率为0，衍生数据集中分别为4.2和17.6％。
结论：

AASL-HCC模型对于接受ETV / TDF治疗的初治CHB患者的HCC风险预测简单可靠，并且易于应用于临床环境。

结论：
    30694912
DOI：
    10.1097 / MEG.0000000000001357