老年和高甲胎蛋白預示慢性乙型肝炎相關肝硬化患者接受長

StephenW

老年和高甲胎蛋白預示慢性乙型肝炎相關肝硬化患者接受長期核苷（酸）類似物治療時發生肝細胞癌的風險更高
Yuh-Ying Liu 1 , Chih-Lang Lin 1 2 , Cheng-Haeng Weng 2 3 , Pei-Hung Chang 2 4 , Cheng-Hung Chien 1 , Kuang-Chen Huang 1 , Man-Chin Hua 2 5 , Ching-Chih Hu 1 2
隸屬關係
隸屬關係

    1
    台灣基隆 20401 長庚紀念醫院腸胃肝內科肝臟研究室
    2
    長庚大學醫學院, 台灣桃園 33302
    3
    台灣桃園 333 林口長庚紀念醫院腎內科腎臟研究中心。
    4
    台灣基隆 20401 長庚紀念醫院腫瘤科
    5
    長庚紀念醫院兒科，基隆，20401，台灣

    PMID：36140487 DOI：10.3390/diagnostics12092085

抽象的

背景：核苷（酸）類似物（NUC）被證明可以減少慢性乙型肝炎（CHB）患者的肝細胞癌（HCC）發展，但其在肝硬化 CHB 患者中的療效數據有限。

方法：對447例接受替諾福韋/恩替卡韋治療的肝硬化CHB患者進行回顧性分析，分為HCC組（n = 48）和非HCC組（n = 399）。中位隨訪時間為 62.1 個月。

結果：共有 48 名患者（10.7%）在監測期間發展為 HCC。 HCC的年發病率為2.04/100人年。 1、5 和 10 年 HCC 的累積發病率分別為 0.9%、9.8% 和 22.1%。使用多重 Cox 回歸分析確定的 HCC 顯著預測因子是年齡≥50 歲（風險比（HR）：2.34）和甲胎蛋白（AFP）≥8 ng/mL（HR：2.05）。年齡≥50歲且AFP≥8 ng/mL的患者（3.14/100人年）HCC發病率是年齡<50歲且AFP <8 ng/mL的患者（0.36）的8.67倍。每 100 人年）。

結論：年齡 <50 歲和 AFP <8 ng/mL 的肝硬化 CHB 患者的 HCC 年發病率最低。然而，年齡 ≥ 50 歲或/和 AFP ≥ 8 ng/mL 的患者發生 HCC 的風險顯著更高，因此需要仔細監測。

關鍵詞：慢性乙型肝炎；肝硬化;累積發病率；恩替卡韋；肝細胞癌;發病率;風險;替諾福韋。

StephenW

Older Age and High α-Fetoprotein Predict Higher Risk of Hepatocellular Carcinoma in Chronic Hepatitis-B-Related Cirrhotic Patients Receiving Long-Term Nucleos(t)ide Analogue Therapy
Yuh-Ying Liu  1 , Chih-Lang Lin  1   2 , Cheng-Hao Weng  2   3 , Pei-Hung Chang  2   4 , Cheng-Hung Chien  1 , Kuang-Chen Huang  1 , Man-Chin Hua  2   5 , Ching-Chih Hu  1   2
Affiliations
Affiliations

    1
    Liver Research Unit, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Keelung 20401, Taiwan.
    2
    College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
    3
    Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
    4
    Department of Oncology, Chang Gung Memorial Hospital, Keelung 20401, Taiwan.
    5
    Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, 20401, Taiwan.

    PMID: 36140487 DOI: 10.3390/diagnostics12092085

Abstract

Background: Nucleos(t)ide analogues (NUCs) were proved to reduce hepatocellular carcinoma (HCC) development in chronic hepatitis B (CHB) patients, but data were limited on their efficacy in cirrhotic CHB patients.

Methods: A total of 447 cirrhotic CHB patients treated with tenofovir/entecavir were retrospectively analyzed and divided into HCC (n = 48) and non-HCC (n = 399) groups. The median follow-up period was 62.1 months.

Results: A total of 48 patients (10.7%) developed HCC during surveillance. The annual incidence rate of HCC was 2.04 per 100 person-years. The cumulative incidence of HCC was 0.9%, 9.8%, and 22.1% at 1, 5, and 10 years, respectively. Significant predictors for HCC identified using a multiple Cox regression analysis were age ≥50 years (hazard ratio (HR): 2.34) and α-fetoprotein (AFP) ≥8 ng/mL (HR: 2.05). The incidence rate of HCC was 8.67-fold higher in patients with age ≥50 years and AFP ≥8 ng/mL (3.14 per 100 person-years) than those with age &lt;50 years and AFP &lt;8 ng/mL (0.36 per 100 person-years).

Conclusions: Cirrhotic CHB patients with age &lt;50 years and AFP &lt;8 ng/mL had the lowest annual incidence of HCC. However, those with age ≥50 years or/and AFP ≥8 ng/mL had a significantly higher risk for HCC development and warrant a careful surveillance schedule.

Keywords: chronic hepatitis B; cirrhosis; cumulative incidence; entecavir; hepatocellular carcinoma; incidence rate; risk; tenofovir.