Subcirrhotic liver stiffness by FibroScan correlates with lower risk of hepatocellular carcinoma in patients with HBV-related cirrhosis
Subcirrhotic liver stiffness by FibroScan correlates with lower risk of hepatocellular carcinoma in patients with HBV-related cirrhosis
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DOI：
10.1007/s12072-017-9789-y
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发表时间：
2017-05-01
影响因子：
6.6
通讯作者：
Han, Kwang-Hyub
中科院分区：
文献类型：
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作者：
Jeon, Mi Young;Lee, Hye Won;Han, Kwang-Hyub
即使在肝硬化的情况下，发生肝细胞癌 (HCC) 的风险也各不相同。我们研究了通过瞬时弹性成像 (TE) 评估的亚肝硬化范围内的肝脏硬度 (LS) 与慢性乙型肝炎 (CHB) 相关肝硬化患者发生 HCC 的风险之间的关系。对 2006 年 4 月至 2014 年 12 月期间 540 名临床明显的 CHB 相关肝硬化患者的数据进行了回顾性分析。 LS 亚肝硬化范围由 TE 值 13 kPa 定义。在研究人群中，214 人 (39.6%) 的 LS 值处于肝硬化亚范围内。在随访期间（中位时间 54.1 个月），81 名患者 (15.0%) 发展为 HCC。与年龄、男性和糖尿病相结合，亚肝硬化 LS 值（风险比 = 0.462）是多变量分析中 HCC 发展的独立预测因子（所有 p < 0.05）。亚肝硬化（与肝硬化）LS 范围内的患者的 HCC 累积发病率显着较低（对数秩检验，p < 0.05）。在我们的队列中，修改后的 REACH-B 评分优于其他预测模型，即 REACH-B、CU-HCC 和 LSM-HCC 评分系统（接受者操作特征曲线下面积：7 年 HCC 风险分别为 0.717 与 0.669、0.578 和 0.624）。 CHB 相关的肝硬化。因此，即使对于具有相同肝硬化疾病类别的患者，也可能需要不同的基于 TE 的 HCC 监测策略。
The risk of developing hepatocellular carcinoma (HCC) varies, even in the context of cirrhosis. We investigated the relationship between liver stiffness (LS) in subcirrhotic range, assessed via transient elastography (TE), and risk of HCC development in patients with chronic hepatitis B (CHB)-related cirrhosis.Data on 540 patients presenting with clinically evident CHB-related cirrhosis between April 2006 and December 2014 were reviewed retrospectively. Subcirrhotic range of LS was defined by TE values 13 kPa.Of the study population, 214 (39.6%) had LS values in the subcirrhotic range. During follow-up (median 54.1 months), 81 patients (15.0%) developed HCC. In conjunction with age, male gender, and diabetes mellitus, subcirrhotic LS value (hazard ratio = 0.462) was an independent predictor of HCC development on multivariate analysis (all p < 0.05). Cumulative HCC incidence was significantly lower for patients in subcirrhotic (versus cirrhotic) LS range (log-rank test, p < 0.05). In our cohort, the modified REACH-B score performed better than other prediction models, namely REACH-B, CU-HCC, and LSM-HCC scoring systems (area under receiver operating characteristic curve: 0.717 versus 0.669, 0.578, and 0.624, respectively, for 7-year HCC risk).A significant association between subcirrhotic range of LS value and lower risk of HCC development was identified in patients with clinically evident CHB-related cirrhosis. Thus, different TE-based HCC surveillance strategies may be required even in patients with identical liver cirrhosis disease category.