血清甲胎蛋白的最小增加预示着在长期口服治疗下高加索人HB

StephenW

Liver Int. 2019 Jul 19. doi: 10.1111/liv.14197. [Epub ahead of print]
Minimal increases of serum alpha-fetoprotein herald HCC detection in Caucasian HBV cirrhotic patients under long-term oral therapy.
Loglio A1, Iavarone M1, Viganò M2, Orenti A3, Facchetti F1, Cortinovis I3, Lunghi G4, Ceriotti F4, Occhipinti V2, Rumi M2, Sangiovanni A1, Colombo M5, Lampertico P1.
Author information

1
    CRC "A. M. and A. Migliavacca" Center for the Study of Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
2
    Division of Hepatology, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy.
3
    Department of Clinical Sciences and Community Health, Laboratory of Statistics, Epidemiology and Biometry "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy.
4
    Virology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
5
    Center for Translational Hepatology Research, Clinical and Research Center, Humanitas Hospital, Rozzano, Italy.

Abstract
BACKGROUND & AIMS:

In Caucasian patients with compensated cirrhosis due to hepatitis B virus (HBV), the risk of hepatocellular carcinoma (HCC) developing persist despite long-term nucleos(t)ide analogs (NUC) treatment. In the surveillance of this population with persistently normal transaminases due to NUCs, the added value of serum alpha-fetoprotein (AFP) monitoring is poorly defined.
METHODS:

258 Caucasian HCC-free patients with HBV compensated cirrhosis who started tenofovir or entecavir while having normal serum AFP levels (≤7 ng/mL) at baseline or within the first year of treatment underwent HCC surveillance by semiannual ultrasound evaluation and serum AFP determination.
RESULTS:

During 96 (18-120) months of antiviral therapy, 3,947 AFP values were collected, median AFP level was 2 ng/mL. 35 patients developed an HCC at an overall 8-year crude cumulative incidence of 14% (annual incidence of 2%). HCC incidence increased in parallel with increasing AFP thresholds: 24%, 36%, 64% and 92% for AFP levels after exceeding 2, 4, 6 and 7 ng/mL for the first-time. Of the 12 patients who experienced an AFP rise >7 ng/mL, 11 developed an HCC and one had liver metastases of lung cancer. Overall, an AFP >7 ng/mL had 99.6% specificity, 31.4% sensitivity, 91.7% PPV, 90.2% NPV, LR+ 70.1, and LR- 0.69 for HCC; this excellent specificity was maintained up to 18 months before HCC detection.
CONCLUSIONS:

In Caucasian patients with HBV compensated cirrhosis on long-term NUC, an increase of AFP over 7 ng/mL shows excellent specificity, heralding HCC development within one year. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.
KEYWORDS:

Alpha-fetoprotein; Diagnostic tests; Hepatitis B; Hepatocellular Carcinoma; Surveillance

PMID:
    31323159
DOI:
    10.1111/liv.14197

StephenW

肝脏国际2019年7月19日doi：10.1111 / liv.14197。 [印刷前的电子版]
血清甲胎蛋白的最小增加预示着在长期口服治疗下高加索人HBV肝硬化患者的HCC检测。
Loglio A1，Iavarone M1，ViganòM2，Orenti A3，Facchetti F1，Cortinovis I3，Lunghi G4，Ceriotti F4，Occhipinti V2，Rumi M2，Sangiovanni A1，Colombo M5，Lampertico P1。
作者信息

1
CRC“A. M.和A. Migliavacca”肝病研究中心，消化内科和肝脏病学，FondazioneIRCCSCàGrandaOspedale Maggiore Policlinico，意大利米兰大学。
2
意大利米兰米兰大学Ospedale San Giuseppe肝脏病学系。
3
意大利米兰米兰大学临床科学与社区卫生系，统计学，流行病学与生物学实验室“G.A. Maccacaro”。
4
病毒学部门，FondazioneIRCCSCàGrandaOspedale Maggiore Policlinico，意大利米兰大学米兰学院。
五
意大利罗扎诺Humanitas医院转化肝病研究中心，临床和研究中心。

抽象
背景与目的：

在由乙型肝炎病毒（HBV）引起的代偿性肝硬化的白种人患者中，尽管长期核苷（酸）类似物（NUC）治疗，但肝细胞癌（HCC）发展的风险仍然存在。在对具有持续正常的转氨酶的该群体的监测中由于NUC，血清甲胎蛋白（AFP）监测的附加值定义不明确。
方法：

258名患有HBV代偿性肝硬化的无HCC患者，在基线或治疗第一年内开始使用替诺福韦或恩替卡韦，同时血清AFP水平正常（≤7ng/ mL），通过半年超声评估和血清AFP测定进行HCC监测。
结果：

在96（18-120）个月的抗病毒治疗期间，收集了3,947个AFP值，中位AFP水平为2 ng / mL。 35名患者发生HCC，总体8年原油累积发生率为14％（2％HCC发病率的年发病率随着AFP阈值的增加而增加：超过2时AFP水平的24％，36％，64％和92％首次，4,6和7 ng / mL。在AFP升高> 7 ng / mL的12例患者中，11例发生HCC，1例发生肺癌肝转移。总体而言，AFP> 7 ng / mL对HCC具有99.6％的特异性，31.4％的敏感性，91.7％的PPV，90.2％的NPV，LR + 70.1和LR-0.69;这种优异的特异性在HCC检测前保持长达18个月。
结论：

在长期NUC患有HBV代偿性肝硬化的白种人患者中，AFP增加超过7 ng / mL显示出优异的特异性，预示HCC在一年内发展。本文受版权保护。

本文受版权保护。版权所有。
关键词：

甲胎蛋白;诊断测试;乙型肝炎;肝细胞癌;监控

结论：
31323159
DOI：
10.1111 / liv.14197