口服抗病毒疗法治疗的慢性乙型肝炎患者的肝细胞癌预测的RE

StephenW

J Infect Dis. 2019 Sep 24. pii: jiz477. doi: 10.1093/infdis/jiz477. [Epub ahead of print]
REAL-B (Real-world Effectiveness from the Asia Pacific Rim Liver Consortium for HBV) Risk Score for the Prediction of Hepatocellular Carcinoma in Chronic Hepatitis B Patients Treated with Oral Antiviral Therapy.
Yang HI1,2, Yeh ML3, Wong GL4, Peng CY5, Chen CH6, Trinh HN7, Cheung KS8, Xie Q9, Su TH10, Kozuka R11, Lee DH12, Ogawa E13, Zhao C14, Ning HB15, Huang R16, Li J17, Zhang JQ18, Ide T19, Xing H20, Iwane S21, Takahashi H21, Wong C22, Wong C22, Lin CH5, Hoang J23, le A23, Henry L23, Toyoda H24, Ueno Y25, Gane EJ26, Eguchi Y21, Kurosaki M27, Wu C16, Liu C14, Shang J15, Furusyo N13, Enomoto M11, Kao JH10, Yuen MF8, Yu ML3, Nguyen MH23.
Author information

1
    Genomics Research Center, Academia Sinica, Taipei, Taiwan.
2
    Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
3
    Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
4
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
5
    Department of Gastroenterology, China Medical University Hospital, Taichung, Taiwan ROC.
6
    Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
7
    San Jose Gastroenterology, San Jose, CA, USA.
8
    Department of Medicine, The University of Hong Kong, Hong Kong.
9
    Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PRC.
10
    Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
11
    Department of Hepatology, Osaka City University Graduate School of Medicine, Osaka, Japan.
12
    Department of Gastroenterology, Good Gang-An Hospital, Busan, South Korea.
13
    Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
14
    Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of T.C.M., Shanghai, PRC.
15
    Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, PRC.
16
    Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, PRC.
17
    Palo Alto Medical Foundation, Mountain View Division, Mountain View, CA, USA.
18
    Chinese Hospital, San Francisco, CA, USA.
19
    Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan.
20
    Beijing Ditan Hospital, Capital Medical University, Beijing, PRC.
21
    Department of Internal Medicine, Saga University Hospital, Saga, Japan.
22
    Wong Clinics, San Francisco, CA, USA.
23
    Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA.
24
    Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
25
    Department of Gastroenterology, Yamagata University, Yamagata, Japan.
26
    Liver Transplant Unit, University of Auckland, Auckland, New Zealand.
27
    Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.

Abstract
BACKGROUND:

Patients on oral antiviral (OAV) therapy remain at HCC risk. Risk prediction tools distinguishing treated patients with residual HCC risk are limited. Aim: Develop an accurate, precise, simple-to-use HCC risk score using routine clinical variables among a treated Asian cohort.
METHODS:

Routine practice adult Asian CHB patients on OAV were recruited from 25 centers in the US and Asia-Pacific region. Excluded persons were co-infected with hepatitis C, D, or HIV, had HCC prior to or within 1 year of study entry or their follow-up was <1 year. Patients were randomized to derivation and validation cohorts on a 2:1 ratio. Statistically significant predictors from multivariate modeling formed the REAL-B score.
RESULTS:

A total of 8,048 patients were randomized to the derivation (n=5,365) or validation group (n=2,683).The REAL-B model included 7 variables (male gender, age, alcohol use, diabetes, baseline cirrhosis, platelet count, and AFP) scores were categorized as: 0-3 low risk, 4-7 moderate risk, and 8-13 high risk. AUROCs were >0.80 for HCC risk at 3, 5, and 10 years, and were significantly higher than other risk models (p<0·001).
CONCLUSION:

The REAL-B score provides three distinct risk categories for HCC development in Asian CHB patients on OAV guiding HCC surveillance strategy.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].
KEYWORDS:

Asian; liver cancer; treatment; viral hepatitis; viral suppression

PMID:
    31550363
DOI:
    10.1093/infdis/jiz477

StephenW

感染杂志2019年9月24日。pii：jiz477。 doi：10.1093 / infdis / jiz477。 [Epub提前发布]
口服抗病毒疗法治疗的慢性乙型肝炎患者的肝细胞癌预测的REAL-B（亚太环肝联盟对HBV的实际疗效）风险评分。
Yang HI1,2，Yeh ML3，Wong GL4，Peng CY5，Chen CH6，Trinh HN7，Cheung KS8，Xie Q9，Su TH10，Kozuka R11，Lee DH12，Ogawa E13，Zhao C14，Ning HB15，Huang R16，Li J17，张JQ18，井德T19，邢H20，岩手S21，高桥H21，黄C22，黄C22，林CH5，黄J23，le A23，亨利L23，丰田H24，上野Y25，甘恩EJ26，江口Y21，黑崎M27，吴C16 ，Liu C14，Shang J15，Furusyo N13，Enomoto M11，Kao JH10，Yuen MF8，Yu ML3，Nguyen MH23。
作者信息

1
    中国台湾省中央研究院基因组学研究中心。
2
    国立阳明大学临床医学研究所，台湾台北。
3
    高雄医科大学内科，台湾高雄。
4
    香港中文大学医学与治疗学系，香港。
五
    中国台湾台中中国医科大学附属医院消化内科。
6
    台湾高雄市长庚纪念医院和长庚大学医学院内科。
7
    美国加利福尼亚州圣何塞，圣何塞胃肠病学。
8
    香港大学医学系，香港。
9
    上海交通大学医学院附属瑞金医院传染病科，上海
10
    国立台湾大学附属医院肝炎研究中心，台湾台北。
11
    日本大阪市立大学医学研究生院肝病学系。
12
    韩国釜山Good Gang-An医院消化内科。
13
    日本福冈九州大学医院普通内科。
14
    上海中医药大学附属曙光医院肝病研究所肝硬化科
15
    河南省人民医院传染病科，郑州。
16
    南京大学医学院南京鼓楼医院传染病科，江苏南京
17
    美国加利福尼亚州山景城帕洛阿尔托医学基金会，山景城分部。
18
    美国加利福尼亚州旧金山中国医院。
19
    日本福冈久留米大学医学院内科。
20
    首都医科大学附属北京地坛医院，中国北京。
21
    日本佐贺县佐贺大学附属医院内科。
22
    Wong诊所，美国加利福尼亚州旧金山。
23
    斯坦福大学医学院胃肠病学和肝病学系，美国加利福尼亚州帕洛阿尔托。
24
    日本大垣市大垣市立医院消化内科。
25
    日本山形大学山形大学消化内科。
26
    奥克兰大学肝移植单位，新西兰奥克兰。
27
    日本东京武藏野红十字医院消化内科和肝病科。

抽象
背景：

接受口服抗病毒（OAV）治疗的患者仍有HCC风险。区分残留的HCC风险的已治疗患者的风险预测工具有限。目的：利用治疗的亚洲人群中的常规临床变量，制定准确，准确，易于使用的HCC风险评分。
方法：

从美国和亚太地区的25个中心招募了接受OAV治疗的常规成人亚洲CHB患者。排除的患者在进入研究之前或之内合并感染了丙型肝炎，丁型肝炎或艾滋病毒，并患有HCC，或者其随访时间小于1年。患者按2：1的比例随机分配至派生和验证队列。来自多元建模的具有统计学意义的预测变量形成了REAL-B得分。
结果：

总共8,048例患者被随机分为派生组（n = 5,365）或验证组（n = 2,683）.REAL-B模型包括7个变量（男性，年龄，饮酒，糖尿病，基线期肝硬化，血小板计数和AFP）分数分为：0-3低风险，4-7中度风险和8-13高风险。在3年，5年和10年时，肝癌风险的AUROCs> 0.80，并且显着高于其他风险模型（p <0·001）。
结论：

REAL-B评分通过OAV指导HCC监测策略，为亚洲CHB患者的HCC发育提供了三种不同的风险类别。

©作者2019.牛津大学出版社，美国传染病学会出版。版权所有。有关权限，请发送电子邮件至：[email protected]。
关键词：

亚洲;肝癌;治疗;病毒性肝炎;病毒抑制

结论：
    31550363
DOI：
    10.1093 / infdis / jiz477