根據PAGE-B評分根據肝細胞癌風險對慢性乙型肝炎患者進行個

StephenW

Individualized surveillance of chronic hepatitis B patients according to hepatocellular carcinoma risk based on PAGE-B scores
Ji Hyun Kim  1 , Seong Hee Kang  2 , Minjong Lee  3 , Hoon Sung Choi  1 , Baek Gyu Jun  4 , Tae Suk Kim  1 , Dae Hee Choi  1 , Ki Tae Suk  5 , Moon Young Kim  2 , Young Don Kim  4 , Gab Jin Cheon  4 , Soon Koo Baik  2 , Dong Joon Kim  5
Affiliations
Affiliations

    1
    Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon.
    2
    Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju.
    3
    Department of Internal Medicine, Ewha Womans University College of Medicine, Ewha Womans University Seoul Hospital, Seoul.
    4
    Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung.
    5
    Department of Internal Medicine, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea.

    PMID: 32804840 DOI: 10.1097/MEG.0000000000001870

Abstract

Background and aims: Current guidelines for chronic hepatitis B (CHB) patients are to undergo surveillance for hepatocellular carcinoma (HCC) with 6-month ultrasonography. We aimed to compare detection rates of very-early-stage HCC in two groups: group A, undergoing 6-month ultrasonography versus group B, undergoing 6-month ultrasonography alternating with dynamic computed tomography (CT).

Methods: This retrospective study assessed 2151 CHB patients under entecavir/tenofovir therapy from 2007 to 2016. Detection rates of very-early-stage HCC were compared between groups A/B at intermediate/high risk based on platelets, age, gender-hepatitis B scores. The primary endpoint was the proportion of patients in each group with very-early-stage HCC. Cox proportional hazards model was used to assess the effect of surveillance modalities to detect very-early-stage HCC.

Results: Five-year cumulative HCC incidence rates in group A were 15.0% not significantly different from 18.2% in group B at high risk (P = 0.17). Detection rates of very-early-stage HCC were significantly higher in group B than in group A (P < 0.001), and surveillance using CT alternating with ultrasonography was significantly associated with detection of very-early-stage HCC (hazard ratio 3.89, P < 0.001). Among intermediate-risk patients, difference between detection rates of very-early-stage HCC in groups A and B was not significant (P = 0.30), and surveillance using CT alternating with ultrasonography was not significantly associated with detection of very-early-stage HCC (hazard ratio 1.61, P = 0.23).

Conclusion: In high-risk CHB patients, surveillance using CT alternating with ultrasonography led to higher detection rates of very-early-stage HCC compared to surveillance using ultrasonography.

StephenW

根據PAGE-B評分根據肝細胞癌風險對慢性乙型肝炎患者進行個體化監測
Ji Hyun Kim 1，Seong Hee Kang 2，Minjong Lee 3，Houng Sung Choi 1，Baek Gyu Jun 4，Tae Suk Kim 1，Dae Hee Choi 1，Ki Tae Suk 5，Moon Young Kim 2，Young Don Kim 4，Gab鎮川4，順九白2，董俊金5
隸屬關係
隸屬關係

    1個
    江原國立大學醫學院附屬春川醫院內科
    2
    延世大學原州遣返基督教醫院內科，原州醫學院。
    3
    梨花女子大學醫學院附屬醫院內科，首爾梨花女子大學首爾醫院。
    4
    蔚山大學醫學院江陵市牙山醫院內科。
    5
    大韓民國春川市春川聖心醫院哈林大學醫學院內科。

    PMID：32804840 DOI：10.1097 / MEG.0000000000001870

抽象

背景與目的：當前的慢性乙型肝炎（CHB）患者指南將接受6個月的超聲檢查以監測肝細胞癌（HCC）。我們旨在比較兩組早期HCC的檢出率：A組進行6個月的超聲檢查與B組進行6個月的超聲檢查和動態計算機斷層掃描（CT）交替進行。

方法：這項回顧性研究評估了2007年至2016年接受恩替卡韋/替諾福韋治療的2151名CHB患者。根據血小板，年齡，性別，乙型肝炎，比較了中/高危A / B組中早期HCC的檢出率。分數。主要終點是每組早期肝癌患者的比例。使用Cox比例風險模型評估監測模式對早期HCC的影響。

結果：A組五年累計HCC發生率為15.0％，與高危B組的18.2％差異無統計學意義（P = 0.17）。 B組極早期HCC的檢出率顯著高於A組（P <0.001），並且CT結合超聲檢查與超早期HCC的檢出顯著相關（危險比3.89，P <0.001）。在中危患者中，A組和B組的早期HCC檢出率之間的差異不顯著（P = 0.30），並且使用CT和超聲檢查交替監測與早期階段的檢測無顯著相關性HCC（危險比1.61，P = 0.23）。

結論：在高危CHB患者中，與超聲檢查相比，CT結合超聲檢查進行超早期HCC的檢出率更高。