基于血清纤维化指数的风险评分可预测未经治疗的慢性乙型

StephenW

Serum fibrosis index-based risk score predicts hepatocellular carcinoma in untreated patients with chronic hepatitis B
Lilian Yan Liang  1   2   3 , Hye Won Lee  4 , Vincent Wai-Sun Wong  1   2   3 , Terry Cheuk-Fung Yip  1   2   3 , Yee-Kit Tse  1   2   3 , Vicki Wing-Ki Hui  1   2   3 , Grace Chung-Yan Lui  2   3 , Henry Lik-Yuen Chan  1   2   3 , Grace Lai-Hung Wong  1   2   3
Affiliations
Affiliations

    1
    Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR.
    2
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR.
    3
    Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR.
    4
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.

    PMID: 33631920 DOI: 10.3350/cmh.2020.0333

Abstract

Background/aim: Serum fibrosis scores comprised of common laboratory tests have high utility to assess severity of liver fibrosis. We aimed to derive and validate a hepatocellular carcinoma (HCC) risk score based on serum fibrosis scores to predict HCC in treatment-naïve chronic hepatitis B (CHB) patients.

Methods: 15,187 treatment-naïve adult CHB patients were identified to form the training cohort in this retrospective study. Individual fibrosis score was included to construct a new HCC prediction score. The score was externally validated in an independent treatment-naïve Korean CHB cohort.

Results: 180/15,187 patients (1.2%) in training cohort and 47/4,286 patients (1.1%) in validation cohort developed HCC during a mean follow-up of 52 and 50 months, respectively. The newly developed HCC risk score, Liang score, is composed of gender, age, HBV DNA, FIB-4 index, and ranges from 0 to 22. Area under the time-dependent receiver operating characteristic curve of Liang score was 0.79 (95% CI: 0.70-0.89). A cutoff value of 9 provided an extremely high negative predictive value of 99.9% and high sensitivity of 90.0% at 5 years in the validation cohort; which were higher than those of CU-HCC score, GAG-HCC score and REACH-B score. Patients with Liang score ≤9 had HCC incidence <0.2% per year in both training and validation cohorts, in whom HCC surveillance might be exempted.

Conclusion: A novel HCC risk score, Liang score, based on FIB-4 index, is applicable and accurate to identify treatment-naïve CHB patients with very low risk of HCC to be exempted from HCC surveillance.

Keywords: Fibrosis-4; Hepatocellular carcinoma; Liver fibrosis; Serum-test formulae.

StephenW

基于血清纤维化指数的风险评分可预测未经治疗的慢性乙型肝炎患者的肝细胞癌
Lilian Yan Liang 1 2 3，Hye Won Lee 4，Vincent Wai-Sun Wong 1 2 3，Terry Cheuk-Fung叶1 2 3，Tye-Kit Tse 1 2 3，Vicki Wing-Ki Hui 1 2 3，Grace Chung-严蕾2 3，陈力源1 2 3，黄丽红1 2 3
隶属关系
隶属关系

    1个
    香港特别行政区香港中文大学消化系统疾病研究所。
    2
    香港特别行政区香港中文大学医学与治疗学系。
    3
    香港特别行政区香港中文大学医学数据分析中心（MDAC）。
    4
    延世大学医学院内科，韩国首尔。

    PMID：33631920 DOI：10.3350 / cmh.2020.0333

抽象的

背景/目的：由常见的实验室检查组成的血清纤维化评分对评估肝纤维化的严重程度具有很高的实用性。我们旨在根据血清纤维化评分得出并验证肝细胞癌（HCC）风险评分，以预测未接受治疗的慢性乙型肝炎（CHB）患者的HCC。

方法：在这项回顾性研究中，确定了15187名未接受过治疗的成人CHB患者组成了训练队列。包括个体纤维化评分以构建新的HCC预测评分。这项得分在未进行过独立治疗的韩国CHB队列中进行了外部验证。

结果：在平均随访时间为52个月和50个月的训练队列中，有180 / 15,187例患者（1.2％），在验证队列中有47 / 4,286例患者（1.1％）。新开发的HCC风险评分Liang评分由性别，年龄，HBV DNA，FIB-4指数组成，范围为0到22。Liang评分随时间变化的受体工作特征曲线下面积为0.79（95％ CI：0.70-0.89）。在验证队列中，截止值9提供了极高的59.9年阴性预测值99.9％和高灵敏度90.0％。分别高于CU-HCC评分，GAG-HCC评分和REACH-B评分。在训练和验证队列中，Liang得分≤9的患者每年的HCC发生率均<0.2％，其中可以免除HCC监测。

结论：基于FIB-4指数的新型HCC风险评分Liang评分适用于并准确地识别初治的CHB患者，其极低的HCC风险可免于HCC监测。

关键字：Fibrosis-4；肝细胞癌；肝纤维化；血清测试配方。

StephenW

https://www.e-cmh.org/upload/pdf/cmh-2020-0333.pdf