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
明智高
, 元锡康
ORCID 偶像，Kwang Min Kim
, 东贤信
, 郭锦焱
, 白龙汉
， 显示所有
第 70-77 页 | 2021 年 6 月 14 日接收，2021 年 9 月 28 日接受，在线发表：2021 年 11 月 3 日

    下载引文 https://doi.org/10.1080/00365521.2021.1988700 CrossMark Logo CrossMark

抽象的
背景

一些患有慢性乙型肝炎病毒 (HBV) 感染的年轻人可能患肝细胞癌 (HCC) 的风险很高，这足以证明尽管患者年龄较小但定期进行 HCC 监测是合理的。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 单一感染的年轻人（中位年龄：34 岁，男性 66%）进行了基于医院的回顾性队列分析。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每 1000 人年的 HCC 发病率，并且预先定义的患者亚组评估了可用于确定监测目标的独立风险因素。
结果

在整个队列中，HCC 发病率较低（2.55/1000 人年）。然而，HCC 发病率根据基线特征差异很大：FIB-4 ≤ 0.70 的年轻人最低（0.17/1000 人年），而放射性肝硬化的年轻人最高（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 HCC 发展相关的独立因素。预测放射性肝硬化患者年轻发病 HCC 的性能表现出最高的特异性，但敏感性<70%。结合 FIB-4 指数和 HBV DNA 水平，敏感性提高到 90%。
结论

使用 FIB-4 指数、HBV DNA 水平以及结合放射性肝硬化或性别和 AFP 水平的风险分层将有助于对将从常规 HCC 监测中受益和不会受益的年轻患者进行分层。

关键词：肝细胞癌监测FIB-4青年慢性乙型肝炎

StephenW

Incidence and risk factors for development of hepatocellular carcinoma at young age in patients with chronic hepatitis B
Myung Ji Goh
, Wonseok Kang
ORCID Icon, Kwang Min Kim
, Dong Hyun Sinn
, Geum-Youn Gwak
, Yong-Han Paik
, show all
Pages 70-77 | Received 14 Jun 2021, Accepted 28 Sep 2021, Published online: 03 Nov 2021

    Download citation https://doi.org/10.1080/00365521.2021.1988700 CrossMark Logo CrossMark

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: Hepatocellular carcinomasurveillanceFIB-4youngchronic hepatitis B