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
Highlights

    •
    We used a case-control paradigm to investigate HCC screening effectiveness in HBV-infected patients.
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    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.

Background & 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 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 ultrasound 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% vs. 58.6%) or both modalities (19.5% vs. 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% 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.
Lay summary
Patients with hepatitis B infection have a high risk of developing liver cancer. It is therefore recommended that they undergo frequent screening for liver cancer, but whether this leads to a lower risk of dying from liver cancer is not clear. In this study, we show that liver cancer screening is associated with a reduction in the mortality from liver cancer in patients with hepatitis B infection.

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（Noel S.Weiss）
    劳伦·贝斯特（Lauren A.
    帕梅拉·格林（Pamela Green）
    克里斯汀·贝瑞（Kristin Berry）
    乔治·N·约阿努
    显示所有作者

发布时间：2020年11月24日DOI：https：//doi.org/10.1016/j.jhep.2020.11.023
强调

    •
    我们使用病例对照范例研究了在HBV感染患者中进行HCC筛查的有效性。
    •
    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。
    •
    通过超声和​​/或血清AFP筛查HCC与HCC相关死亡率的显着降低有关。

背景与目标
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，但筛查的功效仍不清楚。我们旨在评估超声和/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
我们对通过退伍军人事务（VA）卫生管理部门接受护理的CHB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，而对照组为未死于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年中筛查的超声和AFP（病例）和对照组中的等效索引日期。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个案例，与169个对照组匹配。以筛查方式（33.7％vs. 58.6％）或两种方式（19.5％vs. 34.4％）进行筛查的病例少于对照组。在多条件logistic回归分析中，两种方式的筛查均与较低的肝癌相关死亡率风险相关（校正比值比[aOR] 0.21，95％CI 0.09–0.50），两种方式的筛查也是如此（aOR为0.13； 95） ％CI 0.04-0.43）。
结论
在患有CHB的VA患者中，HCC筛查与HCC相关死亡率的大幅降低有关。
放置摘要
乙型肝炎感染的患者有罹患肝癌的高风险。因此，建议对他们进行频繁的肝癌筛查，但是尚不清楚这是否会降低死于肝癌的风险。在这项研究中，我们表明，肝癌筛查与乙型肝炎感染患者的肝癌死亡率降低有关。