慢性乙型肝炎患者年轻时发生肝细胞癌的发病率和危险因素

StephenW

慢性乙型肝炎患者年轻时发生肝细胞癌的发病率和危险因素
Myung Ji Goh 1、Wonseok Kang 1 2 3、Kwang Min Kim 4、Dong Hyun Sinn 1、Geum-Youn Gwak 1、Yong-Han Paik 1、Moon Seok Choi 1、Joon Hyeok Lee 1、Kwang Cheol Koh 1、Seung Woon白1
隶属关系
隶属关系

    1
    韩国首尔成均馆大学医学院三星医疗中心医学系。
    2
    韩国首尔成均馆大学三星高级健康科学与技术研究所 (SAIHST) 健康科学与技术系。
    3
    韩国首尔三星医学中心未来医学研究所。
    4
    韩国昌原成均馆大学医学院三星昌原医院内科。

    PMID：34731072 DOI：10.1080/00365521.2021.1988700

抽象的

背景：一些慢性乙型肝炎病毒 (HBV) 感染的年轻人可能处于肝细胞癌 (HCC) 的高风险中，足以证明尽管患者年龄很小，但仍需要定期进行 HCC 监测。然而，识别可能从 HCC 监测中受益的高危个体的方法需要进一步评估。

方法：对 2757 名慢性 HBV 单一感染的年轻成人（中位年龄：34 岁，男性 66%）的基于医院的回顾性队列进行了分析。主要结果是年轻发病的 HCC，定义为 40 岁以下的诊断。我们计算了整个队列中的 HCC 发病率/1000 人年，并评估了可用于确定监测目标的独立危险因素的预先定义的患者亚组。

结果：整个队列的 HCC 发病率较低（2.55/1000 人年）。然而，根据基线特征，HCC 发病率差异很大：FIB-4 ≤ 0.70 的年轻成人中最低（0.17/1000 人年），而放射性肝硬化的年轻成人中最高（30.7/1000 人年）。在多变量分析中，放射性肝硬化、FIB-4 指数和血清 HBV DNA 水平是与年轻时发生 HCC 相关的独立因素。预测放射学肝硬化患者中年轻发病的 HCC 的性能表现出最高的特异性，但敏感性<70%。与 FIB-4 指数和 HBV DNA 水平相结合，敏感性增加到 90%。

结论：使用 FIB-4 指数、HBV DNA 水平以及结合放射学肝硬化或性别和 AFP 水平的风险分层将有助于对可能和不会从常规 HCC 监测中受益的年轻患者进行分层。

关键词：FIB-4；肝细胞癌;慢性乙型肝炎;监视;年轻。

StephenW

Incidence and risk factors for development of hepatocellular carcinoma at young age in patients with chronic hepatitis B
Myung Ji Goh  1 , Wonseok Kang  1   2   3 , Kwang Min Kim  4 , Dong Hyun Sinn  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, Sungkyunkwan University School of Medicine, Seoul, South Korea.
    2
    Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
    3
    Research Institute for Future Medicine, Samsung Medicine Center, Seoul, Korea.
    4
    Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.

    PMID: 34731072 DOI: 10.1080/00365521.2021.1988700

Abstract

Background: Some young adults with chronic hepatitis B virus (HBV) infection might be at high risk for hepatocellular carcinoma (HCC), enough to justify regular HCC surveillance despite the young age of the patients. However, ways to identify at-risk individuals who may benefit from HCC surveillance need further evaluations.

Methods: A hospital-based retrospective cohort of 2757 chronic HBV mono-infected young adults (median age: 34 years, males 66%) were analyzed. The primary outcome was young-onset HCC, defined as a diagnosis made under 40 years of age. We calculated the HCC incidence/1000 person-years in the overall cohort and pre-defined subgroups of patients assessed the independent risk factors that can be used to identify surveillance targets.

Results: The HCC incidence was low (2.55/1000 person-years) in the overall cohort. However, the HCC incidence varied widely according to baseline characteristics: lowest among young adults with FIB-4 ≤ 0.70 (0.17/1000 person-years) and highest in young adults with radiological cirrhosis (30.7/1000 person-years). In multivariable analysis, radiological cirrhosis, the FIB-4 index, and serum HBV DNA level were independent factors associated with HCC development at a young age. Performance for prediction of young-onset HCC in radiological cirrhotic patients showed the highest specificity but sensitivity was <70%. Combination with FIB-4 index and HBV DNA levels increased sensitivity to 90%.

Conclusion: Risk stratification using FIB-4 index, HBV DNA levels, and either combining radiological cirrhosis or gender and AFP levels would be helpful to stratify young patients who would and would not benefit from regular HCC surveillance.

Keywords: FIB-4; Hepatocellular carcinoma; chronic hepatitis B; surveillance; young.