乙型肝炎病毒DNA水平和随访间隔与肝细胞癌复发的关系。

StephenW

JAMA Netw Open. 2020 Apr 1;3(4):e203707. doi: 10.1001/jamanetworkopen.2020.3707.
Association of Hepatitis B Virus DNA Level and Follow-up Interval With Hepatocellular Carcinoma Recurrence.
Wang W1,2, Tian SL1,2, Wang H2,3, Shao CC2,4, Wang YZ1,2, Li YL1,2.
Author information

1
    Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.
2
    Interventional Research Institute of Shandong University, Jinan, China.
3
    Department of Interventional Medicine, Jilin Cancer hospital, Changchun, China.
4
    Center of Evidence-based Medicine, Institute of Medical Sciences, The Second Hospital of Shandong University, Jian, China.

Abstract
Importance:

Antiviral treatment is important in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) comprehensive therapy. A high HBV DNA level is an independent risk factor for HBV-related HCC, but no quantifiable clinical index is available to date.
Objective:

To evaluate the feasibility and availability of the novel HBV DNA quantitation-time index (HDQTI), which includes HBV DNA quantitation and follow-up, to predict HBV-related HCC prognosis.
Design, Setting, and Participants:

This retrospective prognostic study of patients with HCC from multiple centers in China was performed from January 1, 2002, to December 31, 2016. The median follow-up time was 18 months, and the longest follow-up time was 147 months. Data analysis was performed from January 1, 2017, to December 31, 2018.
Main Outcomes and Measures:

Clinical characteristics, antitumor management, antiviral treatment, HDQTI scores, follow-up information, and overall survival were recorded and analyzed. A receiver operating characteristic curve and accompanying area under the curve were calculated for HDQTI.
Results:

A total of 842 patients (mean [SD] age, 61.80 [9.85] years; 513 [60.9%] male) were included in the study. Of all included patients, 734 received no antiviral therapy before diagnosis (no previous diagnosis of HBV infection), 43 underwent nonstandard antiviral therapy, and 65 received regular antiviral therapy. Compared with the group without antiviral treatment, the Barcelona Clinic Liver Cancer (BCLC) stage was earlier (A:B:C, 73.8%:26.2%:0% to 5.7%:65.5%:28.8%, P < .001), the mean (SD) tumor size was smaller (2.89 [1.26] to 7.56 [3.28] cm, P < .001), the ratio of baseline HBV DNA level of more than 105 copies/mL was lower (10.8% to 40.6%, P < .001), and the ratio of the α1-fetoprotein level more than 400 ng/mL was less (21.5% to 78.2%, P < .001) in the standard antiviral treatment group, whereas the nonstandard treatment group was between the 2 groups. Recurrence occurred in 39 of 109 BCLC stage A cases. Patients with HDQTI scores higher than 34 had high risk of recurrence; at this cutoff level, the sensitivity of the HDQTI was 76.9% and the specificity was 92.9%, with an area under curve of 0.928. Patients in various BCLC stages had similar trends in overall survival and HDQTI scores (BCLC stage A: HDQTI score <34, not applicable; HDQTI score ≥34, 44.0 months; 95% CI, 38.3-49.7 months; BCLC stage B: HDQTI score <34, 35.0 months; 95% CI, 33.3-36.7 months; HDQTI score ≥34, 17.0 months; 95% CI, 14.5-19.5 months; P = .002; BCLC stage C: HDQTI score <34, 18.0 months; 95% CI, 16.5-19.6 months; HDQTI scores ≥34, 10.0 months; 95% CI, 8.5-11.5 months; P = .005).
Conclusions and Relevance:

The findings suggest that the HDQTI can be used as an independent prognostic indicator of recurrence in HBV-related HCC. Shorter follow-up intervals and accurate imaging evaluation are recommended in patients with HDQTI scores of 34 or higher.

PMID:
    32338753
DOI:
    10.1001/jamanetworkopen.2020.3707

StephenW

JAMA网络公开赛。 2020 Apr 1; 3（4）：e203707。 doi：10.1001 / jamanetworkopen.2020.3707。
乙型肝炎病毒DNA水平和随访间隔与肝细胞癌复发的关系。
Wang W1,2，Tian SL1,2，Wang H2,3，Shao CC2,4，Wang YZ1,2，Li YL1,2。
作者信息

1个
    山东大学第二医院介入医学科，济南
2
    山东大学介入研究所，济南
3
    吉林省吉林市肿瘤医院介入医学科，长春
4
    山东大学第二医院医学科学研究所循证医学中心

抽象
重要性：

抗病毒治疗在乙肝病毒（HBV）相关的肝细胞癌（HCC）综合治疗中很重要。 HBV DNA高水平是与HBV相关的HCC的独立危险因素，但迄今为止尚无可量化的临床指标。
目的：

评估包括HBV DNA定量和随访在内的新型HBV DNA定量时间指数（HDQTI）的可行性和可用性，以预测HBV相关的HCC预后。
设计，设置和参与者：

这项回顾性预后研究于2002年1月1日至2016年12月31日在中国多个中心开展，对HCC患者进行了回顾性研究。中位随访时间为18个月，最长随访时间为147个月。数据分析于2017年1月1日至2018年12月31日进行。
主要成果和措施：

记录并分析临床特征，抗肿瘤治疗，抗病毒治疗，HDQTI评分，随访信息和总体生存率。计算了HDQTI的接收机工作特性曲线和曲线下的伴随面积。
结果：

研究共纳入842名患者（平均[SD]年龄，61.80 [9.85]岁； 513 [60.9％]男性）。在所有纳入的患者中，有734例在诊断前未接受抗病毒治疗（之前未诊断过HBV感染），43例接受了非标准抗病毒治疗，65例接受了常规抗病毒治疗。与未进行抗病毒治疗的组相比，巴塞罗那临床肝癌（BCLC）阶段更早（A：B：C，73.8％：26.2％：0％至5.7％：65.5％：28.8％，P <0.001），平均（SD）肿瘤尺寸较小（2.89 [1.26]至7.56 [3.28] cm，P <.001），基线HBV DNA水平大于105拷贝/ mL的比例较低（10.8％至40.6％， P <.001），且标准抗病毒治疗组中α1-甲胎蛋白水平大于400 ng / mL的比率较小（21.5％至78.2％，P <.001），而非标准治疗组介于两者之间。 2组。 109例BCLC A期病例中有39例复发。 HDQTI评分高于34的患者具有较高的复发风险；在此临界水平下，HDQTI的灵敏度为76.9％，特异性为92.9％，曲线下面积为0.928。处于BCLC不同阶段的患者的总体生存率和HDQTI得分具有相似的趋势（BCLC A期：HDQTI得分<34，不适用; HDQTI得分≥34，44.0个月; 95％CI，38.3-49.7个月; BCLC B期：HDQTI得分<34，35.0个月; 95％CI，33.3-36.7个月; HDQTI得分≥34，17.0个月; 95％CI，14.5-19.5个月; P = 0.002; BCLC C期：HDQTI得分<34，18.0个月; 95 ％CI，16.5-19.6个月； HDQTI得分≥34，10.0个月； 95％CI，8.5-11.5个月； P = .005）。
结论和相关性：

这些发现表明，HDQTI可以用作HBV相关HCC复发的独立预后指标。对于HDQTI评分为34或更高的患者，建议缩短随访时间并进行准确的影像学评估。

PMID：
    32338753
DOI：
    10.1001 / jamanetworkopen.2020.3707

StephenW

https://jamanetwork.com/journals ... _2020_oi_200172.pdf