乙型肝炎表面抗原血清清除患者肝细胞癌发展的风险和风险

StephenW

Risk and Risk Score Performance of Hepatocellular Carcinoma Development in Patients With Hepatitis B Surface Antigen Seroclearance
Yewan Park  1 , Jeong-Hoon Lee  2 , Dong Hyun Sinn  1 , Jun Yong Park  3 , Minseok Albert Kim  2 , Yoon Jun Kim  2 , Jung-Hwan Yoon  2 , Do Young Kim  3 , Sang Hoon Ahn  3 , Wonseok Kang  1 , Geum-Youn Gwak  1 , Yong-Han Paik  1 , Moon Seok Choi  1 , Joon Hyeok Lee  1 , Kwang Cheol Koh  1 , Seung Woon Paik  1
Affiliations
Affiliations

    1
    Department of Medicine, Samsung Medical Center, Seoul, Korea.
    2
    Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
    3
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

    PMID: 33433118 PMCID: PMC7803670 DOI: 10.14309/ctg.0000000000000290

Free PMC article
Abstract

Introduction: Hepatocellular carcinoma (HCC) can develop among chronic hepatitis B patients after hepatitis B surface antigen (HBsAg) seroclearance. However, whether HCC risk after HBsAg seroclearance differs between antiviral therapy (AVT)-induced or spontaneous seroclearance cases and ways to identify at-risk populations remain unclear.

Methods: A retrospective cohort of 1,200 adult chronic hepatitis B patients who achieved HBsAg seroclearance (median age: 56 years; 824 men; 165 with cirrhosis; 216 AVT-induced cases) were analyzed. The risk of HCC after HBsAg seroclearance and the performance of 6 HCC prediction models were assessed.

Results: During a median of 4.8 years of follow-up (range: 0.5-17.8 years), HCC developed in 23 patients (1.9%). The HCC incidence rate was higher in the AVT-induced cases than that in the spontaneous cases (3.9% vs 0.9% at 5 years). AVT and cirrhosis were independent factors associated with HCC, with HCC incidence rates of 0.5%, 1.2%, 4.0%, and 10.5% at 5 years for spontaneous/no-cirrhosis, AVT-induced/no-cirrhosis, spontaneous/cirrhosis, and AVT-induced/cirrhosis patients, respectively. Among the 6 predictive HCC models tested, Chinese University-HCC score (0.82) showed the highest C-statistics, which was followed by guide with age, gender, HBV DNA, core promoter mutations and cirrhosis (0.81).

Discussion: AVT-induced HBsAg seroclearance was associated with higher HCC risk, especially for patients with cirrhosis, indicating that they need careful monitoring for HCC risk. The HCC risk models were able to stratify the HCC risk in patients with HBsAg seroclearance.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.

StephenW

乙型肝炎表面抗原血清清除患者肝细胞癌发展的风险和风险评分表现
Yewan公园1，Lee Jeong-Hoon 2，Dong Hyun Sinn 1，Jun Yong公园3，Minseok Albert Kim 2，Yoon Jun Kim 2，Jung-Hwan Yoon 2，Do Young Kim 3，Sang Hoon Hohn 3，Wonseok Kang 1，郭锦You 1，白汉汉1，文硕彩1，俊赫利1，姜哲无1，承运白1
隶属关系
隶属关系

    1个
    韩国首尔三星医疗中心内科。
    2
    首尔国立大学医学院内科与肝脏研究所，韩国首尔。
    3
    延世大学医学院内科，韩国首尔。

    PMID：33433118 PMCID：PMC7803670 DOI：10.14309 / ctg.0000000000000290

免费PMC文章
抽象

简介：慢性乙型肝炎患者可在乙型肝炎表面抗原（HBsAg）血清清除后发展为肝细胞癌。但是，HBsAg血清清除后的HCC风险在抗病毒治疗（AVT）诱发的还是自发的血清清除病例之间是否有所不同，以及识别高危人群的方法仍不清楚。

方法：回顾性分析了1200例获得HBsAg血清清除的成人慢性乙型肝炎患者（中位年龄：56岁； 824名男性； 165例肝硬化； 216例AVT诱发的病例）。评估了HBsAg血清清除后的HCC风险和6种HCC预测模型的性能。

结果：在中位随访4.8年（范围：0.5-17.8年）中，有23例患者（1.9％）发生了HCC。 AVT诱发病例的HCC发生率高于自发病例（3.9％vs 5年时的0.9％）。 AVT和肝硬化是与肝癌相关的独立因素，自发性/非肝硬化，AVT诱发/无肝硬化，自发性/肝硬化和AVT诱发/肝硬化患者。在测试的6种预测性HCC模型中，中国大学-HCC得分（0.82）显示出最高的C统计量，其次是年龄，性别，HBV DNA，核心启动子突变和肝硬化的指南（0.81）。

讨论：AVT引起的HBsAg血清清除与更高的HCC风险相关，特别是对于肝硬化患者，这表明他们需要仔细监测HCC风险。 HCC风险模型能够对HBsAg血清清除患者的HCC风险进行分层。

版权所有©2021作者。由Wolters Kluwer Health，Inc.代表美国胃肠病学院出版。