Risk factors for hepatocellular carcinoma at baseline and 1 year after initiation of nucleos(t)ide analog therapy for chronic hepatitis B
Risk factors for hepatocellular carcinoma at baseline and 1 year after initiation of nucleos(t)ide analog therapy for chronic hepatitis B
复制标题
DOI：
10.1002/jmv.28210
复制
发表时间：
2022-10-20
影响因子：
12.7
通讯作者：
Izumi，Namiki
中科院分区：
文献类型：
--
作者：
Kaneko，Shun;Kurosaki，Masayuki;Izumi，Namiki
核苷（酸）类似物（NAs）不能完全抑制慢性B型肝炎（CH B）患者发生肝细胞癌（HCC）的风险。本研究旨在确定接受当前NA治疗的初治CHB患者发生HCC的风险因素。从日本红十字会肝脏研究组的17家医院回顾性招募接受NA的患者（n= 905）。所有初治患者已连续接受当前NA超过1年，直至随访结束。我们使用受试者工作特征曲线下面积分析预测风险评分的准确性。NA治疗显著改善了白蛋白-胆红素（ALBI）评分（-0.171 ± 0.396;第48周p< 0.001）。中位随访时间为6.2（1.03-15.7）年，共有72例（8.0%）患者发生HCC。根据多变量分析，HCC发展的独立预测因素是年龄较大、肝硬化、基线时血小板计数和ALBI评分较低以及NA治疗后1年时的甲胎蛋白（AFP）。使用包括这些因素的PAGE-B、mPAGE-B、aMAP、阿帕-B和真实的-B评分评估准确度。对这些模特来说，歧视一般是可以接受的。aMAP和真实的-B显示出较高的区分度，与NA治疗后1年的状态相比，3年和5年预测值分别为0.866/0.862和0.833/0.859。基线年龄和血小板计数以及NA后一年的ALBI和AFP可用于分层致癌风险。在日本CH B患者中验证了aMAP和真实的B评分的高准确性。
Nucleos(t)ide analogs (NAs) cannot completely suppress the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). This study aimed to identify the risk factors for HCC development in naïve CHB patients treated with current NA. Patients receiving NA (n= 905) were recruited retrospectively from the 17 hospitals of the Japanese Red Cross Liver Study Group. All treatment‐naïve patients had been receiving current NA continuously for more than 1 year until the end of the follow‐up. We analyzed the accuracy of predictive risk score using the area under receiver operating characteristic curve. The albumin–bilirubin (ALBI) score was significantly improved by NA therapy (−0.171 ± 0.396;p< 0.001 at Week 48). A total of 72 (8.0%) patients developed HCC over a median follow‐up of 6.2 (1.03–15.7) years. An independent predictive factor of HCC development was older age, cirrhosis, lower platelet counts at baseline and ALBI score, and alpha‐fetoprotein (AFP) at 1 year after NA therapy according to multivariate analysis. The accuracy was assessed using the PAGE‐B, mPAGE‐B, aMAP, APA‐B, and REAL‐B scores that included these factors. Discrimination was generally acceptable for these models. aMAP and REAL‐B demonstrated high discrimination with 0.866/0.862 and 0.833/0.859 for 3‐ and 5‐year prediction from the status of 1 year after NA therapy, respectively. Baseline age and platelet count, as well as ALBI and AFP one year after NA, were useful for stratifying carcinogenesis risk. The aMAP and REAL‐B scores were validated with high accuracy in Japanese CHB patients.