评估肝细胞癌预测分数在COVID-19时代优先进行乙肝监测的功效

StephenW

Assessing efficacy of hepatocellular carcinoma prediction scores to prioritise hepatitis B surveillance in the COVID-19 era
Ricky Sinharay  1   2 , Andrew J Grant  3 , Lucy Rivett  4   5 , Rebecca Blackwell  2 , George Mells  2 , William Gelson  2
Affiliations
Affiliations

    1
    Department of Pathology University of Cambridge Cambridge UK.
    2
    Cambridge Liver Unit Cambridge University Hospitals NHS Foundation Trust Cambridge UK.
    3
    MRC Biostatistics Unit University of Cambridge Cambridge UK.
    4
    Department of Infectious Diseases Cambridge University NHS Hospitals Foundation Trust Cambridge UK.
    5
    Clinical Microbiology and Public Health Laboratory Public Health England Cambridge UK.

    PMID: 33821150 PMCID: PMC8014760 DOI: 10.1002/ygh2.443

Abstract

Objective: An estimated 250 million people worldwide are chronically infected with hepatitis B virus (HBV), the leading cause of hepatocellular carcinoma (HCC) globally. The novel Sars-cov2 virus continues to spread at an alarming rate, and with guidance at the onset of the pandemic recommending the deferral of HCC surveillance, the implications on liver cancer care are now emerging and highlight the urgent need for reorganisation of services.

Methods: We analysed how five HCC risk prediction scores could aid stratification of patients with chronic HBV. We calculated scores using parameters measured from 3 years prior (where available, n = 17) and at the time of HCC diagnosis in all adult patients with chronic HBV diagnosed with HCC (n = 46), and controls (n = 100). We compared the number of patients requiring cancer surveillance according to each score and regional surveillance guidance.

Results: The aMAP score had the highest discriminatory performance in HCC risk prediction at 3 years (area under receiver-operating characteristic curve (auROC) of 0.824), followed by the mREACH B score (auROC of 0.719), and mPAGE B score (auROC of 0.742). However, only the mREACH B score had a negative predictive value (NPV) >99%. Applying the mREACH B score to our HBV cohort identified 11 patients requiring HCC surveillance, compared with 62 under current guidelines.

Conclusion: The use of HCC risk prediction scores could streamline the surveillance of patients with chronic HBV at a time of extremely limited resources. Overall, the mREACH B score had both a strong discriminatory performance and a high NPV, thus safely identifying low risk patients not requiring surveillance.

Keywords: COVID‐19; cancer risk scores; cancer surveillance; hepatitis B.

© 2021 John Wiley & Sons Ltd.

StephenW

评估肝细胞癌预测分数在COVID-19时代优先进行乙肝监测的功效
Ricky Sinharay 1 2，Andrew J Grant 3，Lucy Rivett 4 5，Rebecca Blackwell 2，George Mells 2，William Gelson 2
隶属关系
隶属关系

    1个
    剑桥大学病理学系英国剑桥。
    2个
    剑桥肝病部门剑桥大学医院NHS基金会信托英国剑桥。
    3
    英国剑桥大学MRC生物统计学单元。
    4
    剑桥大学传染病学系NHS医院基金会信托，英国剑桥。
    5
    临床微生物学和公共卫生实验室英国公共卫生英国剑桥。

    PMID：33821150 PMCID：PMC8014760 DOI：10.1002 / ygh2.443

抽象的

目的：全球估计有2.5亿人长期感染了乙型肝炎病毒（HBV），而乙型肝炎是全球肝细胞癌（HCC）的主要原因。新型Sars-cov2病毒继续以惊人的速度传播，在大流行开始时的指导意见（建议推迟HCC监测）下，对肝癌治疗的影响正在显现，并突出说明了重组服务的迫切需求。

方法：我们分析了五个HCC风险预测得分如何有助于慢性HBV患者的分层。我们使用从3年之前（如果可用，n = 17）和HCC诊断时在所有诊断为HCC的慢性HBV成人患者（n = 46）和对照组（n = 100）中测得的参数计算分数。我们根据每个评分和区域监测指南比较了需要进行癌症监测的患者数量。

结果：aMAP评分在3年的HCC风险预测中具有最高的判别性能（接受者操作特征曲线（auROC下的面积为0.824）），其次是mREACH B评分（auROC为0.719）和mPAGE B评分（auROC）为0.742）。但是，只有mREACH B评分的阴性预测值（NPV）> 99％。将mREACH B评分应用于我们的HBV队列中，确定了11例需要进行HCC监测的患者，而目前的指南为62例。

结论：在资源极其有限的情况下，使用HCC风险预测评分可以简化对慢性HBV患者的监测。总体而言，mREACH B评分具有较强的歧视性表现和较高的NPV，因此可以安全地确定不需要监测的低风险患者。

关键字：COVID-19；癌症风险评分；癌症监测；乙型肝炎

版权©2021 John Wiley＆Sons Ltd.

StephenW

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ygh2.443