通过无创性纤维化标记物治疗慢性乙型肝炎的治疗反应预测

StephenW

Prediction of Hepatocellular Carcinoma by On-Therapy Response of Noninvasive Fibrosis Markers in Chronic Hepatitis B
Heechul Nam  1 , Sung Won Lee, Jung Hyun Kwon, Hae Lim Lee, Sun Hong Yoo, Hee Yeon Kim, Do Seon Song, Pil Soo Sung, U Im Chang, Chang Wook Kim, Soon Woo Nam, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Jin Mo Yang, Nam Ik Han, Jeong Won Jang
Affiliations
Affiliation

    1
    Devision of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; The Catholic University Liver Research Center, Seoul, Republic of Korea.

    PMID: 33734114 DOI: 10.14309/ajg.0000000000001219

Abstract

Introduction: Antiviral therapy improves hepatic fibrosis and reduces hepatocellular carcinoma (HCC) incidence. This study aimed to evaluate whether on-therapy changes in scores for fibrosis index based on 4 factors and aspartate aminotransferase-to-platelet ratio index are associated with HCC development and establish an HCC risk score model incorporating noninvasive fibrosis marker (NFM) response.

Methods: This multicenter study recruited 5,147 patients with chronic hepatitis B (4,028 for derivation cohort and 1,119 for validation cohort) who were given entecavir/tenofovir for >12 months between 2007 and 2018. A risk prediction model for HCC was developed using predictors based on multivariable Cox models, and bootstrapping was performed for validation.

Results: The 10-year cumulative HCC incidence rates were 12.6% and 13.7% in the derivation and validation cohorts, respectively. The risk of HCC significantly differed with early NFM response, with a marked reduction in HCC risk in patients achieving a significant decrease in NFM by 12 months (P < 0.001). NFM response, sex, age, and cirrhosis were independently predictive of HCC. We developed the Fibrosis marker response, Sex, Age, and Cirrhosis (FSAC) score based on regression coefficients of each variable. For the 10-year prediction of HCC, FSAC showed higher C-index values than PAGE-B, modified PAGE-B, CU-HCC, and REACH-B (0.84 vs 0.77, 0.80, 0.77, and 0.67, respectively; all P < 0.005). The predictive performance of FSAC was corroborated in the validation cohort, with higher C-index than other models (all P < 0.050).

Discussion: On-therapy changes in NFM are an independent indicator of HCC risk. FSAC incorporating NFM response is a reliable risk score for risk estimation for HCC with better performance than other models.

Copyright © The American College of Gastroenterology 2021. All Rights Reserved.

StephenW

通过无创性纤维化标记物治疗慢性乙型肝炎的治疗反应预测肝细胞癌
Heechul Nam 1，李成元，郑贤权，李海利，孙洪Yo，金熙妍，杜善松，P秀成，吴琳昌，金昌旭，孙宇南，施贤培，钟英崔承K尹金Yang杨益汉郑元章
隶属关系
联系

    1个
    大韩民国首尔天主教大学医学院内科学系肝病科；天主教大学肝脏研究中心，大韩民国首尔。

    PMID：33734114 DOI：10.14309 / ajg.0000000000001219

抽象的

简介：抗病毒治疗可改善肝纤维化并减少肝细胞癌（HCC）的发生率。这项研究旨在评估基于4个因素的治疗中纤维化指数得分变化以及天冬氨酸转氨酶与血小板比率指数是否与HCC发生有关，并建立包含无创纤维化标记（NFM）反应的HCC风险评分模型。

方法：该多中心研究招募了2007年至2018年之间接受恩替卡韦/替诺福韦治疗超过12个月的5147例慢性乙型肝炎患者（其中4028例为衍生队列，1119例为验证队列）。多变量Cox模型，并进行自举进行验证。

结果：在派生和验证队列中，十年累计HCC发生率分别为12.6％和13.7％。 HCC的风险与早期NFM反应显着不同，患者的NCC显着降低至12个月时，其HCC风险显着降低（P <0.001）。 NFM反应，性别，年龄和肝硬化是HCC的独立预测因素。我们根据每个变量的回归系数开发了纤维化标志物反应，性别，年龄和肝硬化（FSAC）评分。对于HCC的10年预测，FSAC的C指数值高于PAGE-B，改良的PAGE-B，CU-HCC和REACH-B（分别为0.84和0.77、0.80、0.77和0.67；所有P <0.005）。在验证队列中证实了FSAC的预测性能，其C指数高于其他模型（所有P <0.050）。

讨论：NFM的治疗中变化是HCC风险的独立指标。结合NFM响应的FSAC是用于HCC风险评估的可靠风险评分，其性能优于其他模型。

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