筛查与慢性乙型肝炎患者肝细胞癌相关死亡风险降低相关

StephenW

Screening is associated with a lower risk of hepatocellular carcinoma-related mortality in patients with chronic hepatitis B

    Feng Su
    Noel S. Weiss
    Lauren A. Beste
    Pamela Green
    Kristin Berry
    George N. Ioannou
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Published:November 24, 2020DOI:https://doi.org/10.1016/j.jhep.2020.11.023
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HIGHLIGHTS

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    We used a case-control paradigm to investigate HCC screening effectiveness in HBV-infected patients
    •
    We identified 169 cases who died of HCC, matched to 169 controls who did not die of HCC
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    HCC screening by ultrasound and/or serum AFP was associated with a significant reduction in HCC-related mortality

ABSTRACT
Background and Aims
Patients with chronic hepatitis B (CHB) infection routinely undergo screening for hepatocellular carcinoma (HCC), but the efficacy of screening remains unclear. We aimed to evaluate the impact of screening with ultrasound (USS) and/or serum alpha-fetoprotein (AFP) on HCC-related mortality in patients with CHB.
Methods
We performed a matched case-control study of patients with CHB receiving care through the Veterans Affairs (VA) health administration. Cases were patients who died of HCC between 01/01/2004 and 12/31/2017, while controls were patients with CHB who did not die of HCC. Cases were matched to controls by CHB diagnosis date, age, sex, race/ethnicity, cirrhosis, antiviral therapy exposure, hepatitis B e antigen status, and viral load. We identified screening USS and AFPs obtained in the 4 years preceding HCC diagnosis in cases and the equivalent index date in controls. Using conditional logistic regression, we compared cases and controls with respect to receipt of screening. A lower likelihood of screening in cases corresponds to an association between screening and reduced risk of HCC-related mortality.
Results
We identified 169 cases, matched to 169 controls. Fewer cases than controls underwent screening with either screening modality (33.7% versus 58.6%) or both modalities (19.5% versus 34.4%). In multivariable conditional logistic regression, screening with either modality was associated with a lower risk of HCC-related mortality (adjusted odds ratio [aOR] 0.21, 95% confidence interval [CI] 0.09-0.50), as was screening with both modalities (aOR of 0.13, 95% CI 0.04-0.43).
Conclusions
HCC screening was associated with a substantial reduction in HCC-related mortality in VA patients with CHB.

StephenW

筛查与慢性乙型肝炎患者肝细胞癌相关死亡风险降低相关

    冯苏
    诺埃尔·魏斯
    劳伦·贝斯特
    帕梅拉·格林（Pamela Green）
    克里斯汀·贝瑞
    乔治·N·约阿努
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发布时间：2020年11月24日DOI：https：//doi.org/10.1016/j.jhep.2020.11.023
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强调

    •
    我们使用病例对照范例研究了HBV感染患者的HCC筛查有效性
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    我们确定了169例死于HCC的病例，与169例未死于HCC的对照组相匹配
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    通过超声和​​/或血清AFP进行HCC筛查可显着降低HCC相关死亡率

抽象
背景和目标
患有慢性乙型肝炎（CHB）感染的患者通常接受肝细胞癌（HCC）筛查，但筛查的效果仍不清楚。我们旨在评估超声（USS）和/或血清甲胎蛋白（AFP）筛查对CHB患者HCC相关死亡率的影响。
方法
我们通过退伍军人事务（VA）卫生管理局对患有CHB的患者进行了匹配的病例对照研究。病例为2004年1月1日至2017年12月31日之间死于HCC的患者，对照组为未死于HCC的CHB患者。通过CHB诊断日期，年龄，性别，种族/民族，肝硬化，抗病毒治疗暴露，乙型肝炎e抗原状态和病毒载量，将病例与对照进行匹配。我们确定了在肝癌诊断之前的4年中筛查的USS和AFP的病例，并在对照组中确定了等效的索引日期。使用条件逻辑回归，我们比较了病例和对照者接受筛查的情况。病例筛查的可能性较低，对应于筛查与HCC相关死亡率降低的风险之间的关联。
结果
我们确定了169个病例，与169个对照匹配。接受筛查方式（33.7％对58.6％）或两种方式（两种方式（19.5％对34.4％））进行筛查的病例均少于对照组。在多条件logistic回归分析中，采用两种方式进行筛查均与降低两种肝癌相关死亡率的风险相关（校正比值比[aOR] 0.21，95％置信区间[CI] 0.09-0.50），两种方式均进行筛查（aOR 0.13，95％CI 0.04-0.43）。
结论
在患有CHB的VA患者中，HCC筛查可显着降低HCC相关死亡率。

StephenW

https://www.journal-of-hepatolog ... -1/fulltext?rss=yes