优化的慢性乙型肝炎病毒血症控制的肝细胞癌预测模型。

StephenW

Liver Int. 2020 Apr 2. doi: 10.1111/liv.14451. [Epub ahead of print]
An optimized hepatocellular carcinoma prediction model for chronic hepatitis B with well-controlled viremia.
Lee HW1,2,3, Park SY4, Lee M5, Lee EJ5, Lee J5, Kim SU1,2,3, Park JY1,2,3, Kim DY1,2,3, Ahn SH1,2,3, Kim BK1,2,3.
Author information

1
    Department of Internal medicine, Yonsei University College of medicine, Seoul, Republic of Korea.
2
    Institute of Gastroenterology, Yonsei University College of medicine, Seoul, Republic of Korea.
3
    Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
4
    Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
5
    Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea.

Abstract
BACKGROUND AND AIMS:

Hepatocellular carcinoma (HCC) risk in chronic hepatitis B (CHB) substantially decreased in the era of potent antiviral therapy. We developed an optimized HCC risk prediction model for CHB with well-controlled viremia by nucelos(t)ide analogs (NUCs).
METHOD:

We analyzed those who achieved virological response (VR; serum HBV-DNA<2,000 IU/ml on two consecutive assessments) by NUCs. Liver stiffness by transient elastography, ultrasonography, and laboratory tests were performed at the time of confirmed VR. Patients with decompensated cirrhosis or HCC at baseline were excluded. Multivariate Cox-regression analysis was used to determine key variables to construct a novel risk-scoring model.
RESULTS:

Among 1511 patients, 9.5% developed HCC. Cirrhosis on ultrasonography (adjusted HR [aHR] 2.47), Age (aHR 1.04), Male (aHR 1.9), Platelet count<135,000/uL (aHR 1.57), Albumin<4.5 g/dL (aHR 1.77), and liver Stiffness≥11 kPa (aHR 6.09) were independently associated with HCC. Using these, CAMPAS model was developed with c-index of 0.874. The predicted and observed HCC probabilities were calibrated with a reliable agreement. Such results were reproduced from internal validation and external validation among the independent cohort (n=252). The intermediate-risk (CAMPAS model score 75~161) and high-risk (score>161) groups were more likely to develop HCC compared to the low-risk group (score≤75) with statistical significances (HRs; 4.43 and 47.693, respectively; both p<0.001).
CONCLUSION:

CAMPAS model derived through comprehensive clinical evaluation of liver disease allowed the more delicate HCC prediction for CHB patients with well-controlled viremia by NUCs.

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

antiviral therapy; hepatitis B; hepatocellular carcinoma; prediction; virological response

PMID:
    32239602
DOI:
    10.1111/liv.14451

StephenW

肝内科。 2020年4月2日。doi：10.1111 / liv.14451。 [Epub提前发行]
优化的慢性乙型肝炎病毒血症控制的肝细胞癌预测模型。
Lee HW1,2,3，Park SY4，Lee M5，Lee EJ5，Lee J5，Kim SU1,2,3，Park JY1,2,3，Kim DY1,2,3，Ahn SH1,2,3，Kim BK1， 2，3。
作者信息

1个
    延世大学医学院内科，韩国首尔。
2
    延世大学医学院胃肠病研究所，大韩民国首尔。
3
    大韩民国首尔遣散医院延世肝脏中心。
4
    韩国大邱庆北国立大学医院内科。
5
    延世大学医学院生物医学系统信息学系生物统计学合作单位，韩国首尔。

抽象
背景与目的：

在有效的抗病毒治疗时代，慢性乙型肝炎（CHB）的肝细胞癌（HCC）风险大大降低。我们通过nucelos（t）ide类似物（NUCs）为控制良好的病毒血症的CHB开发了优化的HCC风险预测模型。
方法：

我们分析了通过NUCs获得病毒应答（VR；两次连续评估的血清HBV-DNA <2,000 IU / ml）的患者。在确诊为VR时，通过瞬时弹性成像，超声检查和实验室检查对肝脏进行了刚度测定。排除基线时失代偿性肝硬化或HCC患者。多元Cox回归分析用于确定关键变量，以构建新的风险评分模型。
结果：

在1511名患者中，有9.5％发生了HCC。超声检查中的肝硬化（校正后的HR [aHR] 2.47），年龄（aHR 1.04），男性（aHR 1.9），血小板计数<135,000 / uL（aHR 1.57），白蛋白<4.5 g / dL（aHR 1.77）和肝硬度≥ 11 kPa（aHR 6.09）与HCC独立相关。使用这些，开发了CAMPAS模型，c指数为0.874。预测和观察到的HCC概率已通过可靠的协议进行了校准。这些结果是从独立队列中的内部验证和外部验证中复制的（n = 252）。与低风险组（得分≤75）相比，中风险（CAMPAS模型评分为75〜161）和高风险（得分> 161）组更容易发生HCC，具有统计学意义（HR； 4.43和47.693，分别为p <0.001）。
结论：

通过对肝脏疾病进行全面临床评估而得出的CAMPAS模型，可以通过NUC更加精确地预测CHB患者的病毒血症。

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关键字：

抗病毒治疗；乙型肝炎；肝细胞癌；预测;病毒学反应

PMID：
    32239602
DOI：
    10.1111 / liv.14451