Progression Rates by Age, Sex, Treatment, and Disease Activity by AASLD and EASL Criteria: Data for Precision Medicine
Progression Rates by Age, Sex, Treatment, and Disease Activity by AASLD and EASL Criteria: Data for Precision Medicine
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DOI：
10.1016/j.cgh.2021.05.062
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发表时间：
2022-03-11
影响因子：
12.6
通讯作者：
Nguyen, Mindie H.
中科院分区：
文献类型：
--
作者：
Park, Jiyoon;Le, An K.;Nguyen, Mindie H.
背景与目的：抗病毒治疗标准基于疾病进展风险，对无肝硬化的慢性B型肝炎（CH B）患者的肝细胞癌（HCC）监测建议基于0.2%的年发病率阈值。然而，准确和精确的疾病进展估计数据有限。因此，我们的目的是根据2018年美国肝病研究协会和2017年欧洲肝病研究协会指南，确定按年龄，性别，治疗状态和疾病活动分层的肝硬化和HCC发展率。方法：我们分析了来自美国6个中心和亚太国家27个中心的18，338例患者（8914例接受治疗，9424例未接受治疗）。Kaplan-Meier方法用于估计肝硬化或HCC的年进展率（人年）。结果：该队列为63%的男性，平均年龄为46.19岁，基线肝硬化为14.3%，中位随访时间为9.60年。根据美国肝病研究协会的标准，根据年龄、性别和疾病活动程度，肝硬化的年发病率范围为0.07%至3.94%，无肝硬化患者的HCC年发病率范围为0.04%至2.19%，肝硬化患者的HCC年发病率范围为0.40%至8.83%。几个无肝硬化的患者亚组，包括40岁以下的男性和50岁以下的女性，每年的HCC风险接近或超过0.2%。使用欧洲协会的研究发现类似的结果的肝脏critics.CONCLUSION：有很大的变化，即使在慢性乙型肝炎疾病的进展率“低风险”的人群。未来的CHB建模研究，公共卫生规划和HCC监测建议应基于更精确的疾病进展率，基于性别，年龄和疾病活动，加上治疗状态。
BACKGROUND & AIMS: Antiviral treatment criteria are based on disease progression risk, and hepatocellular carci- noma (HCC) surveillance recommendations for patients with chronic hepatitis B (CHB) without cirrhosis is based on an annual incidence threshold of 0.2%. However, accurate and precise disease progression estimate data are limited. Thus, we aimed to determine rates of cirrhosis and HCC development stratified by age, sex, treatment status, and disease activity based on the 2018 American Association for the Study of Liver Diseases and 2017 European Association for the Study of the Liver guidelines.METHODS: We analyzed 18,338 patients (8914 treated, 9424 untreated) from 6 centers from the United States and 27 centers from Asia-Pacific countries. The Kaplan-Meier method was used to estimate annual progression rates to cirrhosis or HCC in person-years.RESULTS: The cohort was 63% male, with a mean age of 46.19 years, with baseline cirrhosis of 14.3% and median follow up of 9.60 years. By American Association for the Study of Liver Diseases criteria, depending on age, sex, and disease activity, annual incidence rates ranged from 0.07% to 3.94% for cirrhosis, from 0.04% to 2.19% for HCC in patients without cirrhosis, and from 0.40% to 8.83% for HCC in patients with cirrhosis. Several subgroups of patients without cirrhosis including males younger than 40 years of age and females younger than 50 years of age had annual HCC risk near or exceeding 0.2%. Similar results were found using European Association for the Study of the Liver criteria.CONCLUSION: There is great variability in CHB disease progression rates even among "lower-risk" populations. Future CHB modeling studies, public health planning, and HCC surveillance recommendation should be based on more precise disease progression rates based on sex, age, and disease activity, plus treatment status.