Risk assessment of hepatocellular carcinoma development by magnetic resonance elastography in chronic hepatitis C patients who achieved sustained virological responses by direct-acting antivirals.
Risk assessment of hepatocellular carcinoma development by magnetic resonance elastography in chronic hepatitis C patients who achieved sustained virological responses by direct-acting antivirals.
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通过磁共振弹性成像对通过直接作用抗病毒药物获得持续病毒学应答的慢性丙型肝炎患者进行肝细胞癌发展的风险评估。
DOI：
10.1111/jvh.13103
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Izumi N
中科院分区：
文献类型：
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作者：
Tamaki N;Higuchi M;Kurosaki M;Kirino S;Osawa L;Watakabe K;Wang W;Okada M;Shimizu T;Takaura K;Takada H;Kaneko S;Yasui Y;Tsuchiya K;Nakanishi H;Itakura J;Takahashi Y;Enomoto N;Izumi N
持续病毒学应答（SVR）后预测肝细胞癌（HCC）的发展具有重要的临床意义，非侵入性标志物用于预测HCC的有用性已被报道。本研究的目的是比较非侵入性标志物预测HCC发展的准确性。共纳入了346例无HCC病史的慢性丙型肝炎患者，这些患者通过直接作用的抗病毒药物实现了SVR。治疗结束后12周测量磁共振弹性成像（MRE）和血清纤维化标志物，并检查随后的HCC发展。平均观察期为26.4 ± 7.9个月，24例患者发生HCC。MRE、紫藤凝集素阳性mac-2结合蛋白和FIB-4预测3年内HCC的肝硬度受试者工作特征曲线下面积分别为0.743、0.697和0.647。肝硬度≥3.75 KPa患者的1/2/3年HCC发生率分别为6.6%、11.9%和14.5%，而肝硬度<3.75 KPa患者的1/2/3年HCC发生率分别为1.4%、2.5%和2.5%（P< 0.001）。多变量分析显示，肝硬度≥3.75是HCC发展的独立预测因素（风险比，3.51; 95%置信区间，1.24 - 9.99）。在亚组分析中，有132例患者<73岁，肝硬度<3.75 KPa，在这些患者中未观察到HCC发展。MRE预测HCC发展的诊断准确性高于血清纤维化标志物，通过MRE测量肝硬度可以识别SVR后HCC发展的高风险和低风险患者。
Prediction of hepatocellular carcinoma (HCC) development after sustained virological response (SVR) is clinically important, and the usefulness of noninvasive markers for prediction HCC have been reported. The aim of this study was to compare the prediction accuracy for HCC development by noninvasive markers. A total of 346 patients with chronic hepatitis C without history of HCC who achieved SVR through direct‐acting antivirals were included. Magnetic resonance elastography (MRE) and serum fibrosis markers were measured 12 weeks after the end of treatment, and the subsequent HCC development was examined. The mean observation period was 26.4 ± 7.9 months, and 24 patients developed HCC. Area under the receiver operating characteristic curve of liver stiffness by MRE,Wisteria floribundaagglutinin‐positive mac‐2 binding protein and FIB‐4 for predicting HCC within 3 years was 0.743, 0.697 and 0.647, respectively. The 1/2/3‐year rates of HCC development in patients with liver stiffness ≥3.75 KPa were 6.6%, 11.9% and 14.5%, whereas they were 1.4%, 2.5% and 2.5% in patients with liver stiffness <3.75 KPa (P< 0.001). Multivariate analysis revealed that liver stiffness ≥3.75 was an independent predictive factor for HCC development (hazard ratio, 3.51; 95% confidence interval, 1.24‐9.99). In subgroup analysis, there were 132 patients who were <73 years old and had liver stiffness <3.75 KPa, and no HCC development was observed in these patients. Diagnostic accuracy for predicting HCC development was higher in MRE than serum fibrosis markers and measurement of liver stiffness by MRE could identify patients with high and low risk of HCC development after SVR.