长期恩替卡韦治疗期间随时间推移与乙型肝炎病毒相关的肝

StephenW

A multi‐center study of trends in hepatitis B virus‐related hepatocellular carcinoma risk over time during long‐term entecavir therapy                                 Seung Up Kim            
            Yong Eun Chon            
            Yeon Seok Seo            
            Hye Won Lee            
            Han Ah Lee            
            Mi Na Kim            
            In Kyung Min            
            Jun Yong Park            
            Do Young Kim            
            Sang Hoon Ahn            
            Won Young Tak            
            Beom Kyung Kim            
            Soo Young Park            
         
      
   
   First published: 27 August 2020
      https://doi.org/10.1111/jvh.13384
   
                              This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/jvh.13384
         
      
               
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         Abstract                        The risk of developing hepatitis B virus (HBV)‐related hepatocellular carcinoma (HCC) is reduced by antiviral therapy. Here, we evaluated the chronological trends in HCC development risk starting in 2007, when entecavir reimbursement was first initiated in South Korea. Treatment‐naïve patients with chronic hepatitis B (CHB) receiving entecavir 0.5 mg/day were stratified into three groups according to entecavir start time: early (2007–2010), middle (2011–2012), and late (2013–2014) cohorts Among 2,442 patients, cumulative probabilities of developing HCC after 1, 3, and 5 years were respectively 1.7%, 5.1%, and 8.2% (early cohort; n=672); 1.5%, 5.1%, and 8.9% (middle cohort; n=757); and 1.2%, 5.3%, and 10.6% (late cohort; n=1013; p>0.05 between each pair). Older age, male, positive hepatitis B e‐antigen, liver cirrhosis, Child‐Pugh class B (vs. A), and lower platelet count significantly predicted HCC development in univariate analysis (p<0.001), whereas entecavir start time (early vs. middle vs. late cohorts) did not affect the risk of HCC development (p=0.457). A multivariate analysis revealed that older age (adjusted hazard ratio (aHR)=1.041), male gender (aHR=2.069), liver cirrhosis (aHR=3.771), and Child‐Pugh class B (vs. A, aHR=1.548) were independently associated with an increased risk of HCC development, whereas higher platelet count was independently associated with a reduced risk of HCC development (aHR=0.993; all p<0.05). In conclusion, the risk of developing HCC among patients receiving entecavir in South Korea has been stable since 2007. To establish more effective HCC surveillance programs, further studies regarding the carcinogenic roles of non‐viral factors are required.
               
   

StephenW

长期恩替卡韦治疗期间随时间推移与乙型肝炎病毒相关的肝细胞癌风险趋势的多中心研究
金承Up
尹恩俊
尹锡徐
李慧媛
李汉雅
金美娜
在庆Min
俊勇公园
金道英
桑勋安
元英德
金om京
秀英公园
首次发布：2020年8月27日
https://doi.org/10.1111/jvh.13384

本文已被接受发表并接受了完整的同行评审，但未经复制编辑，排版，分页和校对过程，因此可能导致此版本与“记录版本”之间存在差异。请引用本文作为doi：10.1111 / jvh.13384
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抗病毒治疗降低了发生乙型肝炎病毒（HBV）相关的肝细胞癌（HCC）的风险。在这里，我们评估了从2007年恩替卡韦报销于韩国开始时开始的HCC发展风险的时间趋势。根据恩替卡韦的开始时间，接受恩替卡韦0.5 mg /天的初治慢性乙型肝炎（CHB）患者分为三组：早期（2007-2010），中期（2011-2012）和晚期（2013-2014）队列在2,442名患者中，在1、3和5年后发生HCC的累积概率分别为1.7％，5.1％和8.2％（早期队列； n = 672）； 1.5％，5.1％和8.9％（中队列； n = 757）；分别为1.2％，5.3％和10.6％（同期队列； n = 1013；每对之间的p> 0.05）。老年，男性，乙型肝炎e抗原阳性，肝硬化，Child-Pugh B级（vs. A）和较低的血小板计数在单因素分析中显着预测了肝癌的发生（p <0.001），而恩替卡韦的开始时间（早期vs （中队列与晚期队列）未影响肝癌发生的风险（p = 0.457）。多元分析显示，年龄较大（调整后的危险比（aHR）= 1.041），男性（aHR = 2.069），肝硬化（aHR = 3.771）和Child-Pugh B级（vs.A，aHR = 1.548）独立地与增加的HCC发生风险相关，而更高的血小板计数独立地与降低的HCC发生风险相关（aHR = 0.993；所有p <0.05）。总之，自2007年以来，韩国接受恩替卡韦治疗的患者发生HCC的风险一直稳定。为建立更有效的HCC监测计划，需要进一步研究非病毒因素的致癌作用。