Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level
Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level
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DOI：
10.1001/jama.295.1.65
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发表时间：
2006-01-04
影响因子：
120.7
通讯作者：
Iloeje, UH
中科院分区：
文献类型：
--
作者：
Chen, CJ;Yang, HI;Iloeje, UH
背景血清B肝炎病毒（HBV）DNA水平是慢性B肝炎患者病毒复制和抗病毒治疗有效性的标志。目的评价血清HBV DNA水平与肝细胞癌风险之间的关系。设计、设置和参与者（年龄30-65岁），B型肝炎表面抗原血清反应阳性，丙型肝炎病毒抗体血清反应阴性，1991年至1992年间，在台湾招募了一个以社区为基础的癌症筛查项目。结果2001年至2010年共发生原发性肝癌164例，死亡346例。随访11.4年，41779人年。肝细胞癌的发生率随着研究入组时血清HBV DNA水平的升高而升高，呈剂量-反应关系，范围从HBV DNA水平低于300拷贝/mL时的108/100000人-年至HBV DNA水平≥ 100万拷贝/mL时的1152/100000人-年。相应的肝细胞癌累积发病率分别为1.3%和14.9%。血清HBV DNA水平与肝癌的生物学梯度保持显著性（P= 10 000 copies/mL），是独立于HBeAg、血清丙氨酸氨基转移酶水平和肝硬化的肝细胞癌的强风险预测因子。
Context Serum hepatitis B virus (HBV) DNA level is a marker of viral replication and efficacy of antiviral treatment in individuals with chronic hepatitis B.Objective To evaluate the relationship between serum HBV DNA level and risk of hepatocellular carcinoma.Design, Setting, and Participants Prospective cohort study of 3653 participants (aged 30-65 years), who were seropositive for the hepatitis B surface antigen and seronegative for antibodies against the hepatitis C virus, recruited to a community-based cancer screening program in Taiwan between 1991 and 1992.Main Outcome Measure Incidence of hepatocellular carcinoma during follow-up examination and by data linkage with the national cancer registry and the death certification systems.Results There were 164 incident cases of hepatocellular carcinoma and 346 deaths during a mean follow-up of 11.4 years and 41779 person-years of follow-up. The incidence of hepatocellular carcinoma increased with serum HBV DNA level at study entry, in a dose-response relationship ranging from 108 per 100 000 person-years for an HBV DNA level of less than 300 copies/mL to 1152 per 100000 person-years for an HBV DNA level of 1 million copies/mL or greater. The corresponding cumulative incidence rates of hepatocellular carcinoma were 1.3% and 14.9%, respectively. The biological gradient of hepatocellular carcinoma by serum HBV DNA levels remained significant (P= 10 000 copies/mL) is a strong risk predictor of hepatocellular carcinoma independent of HBeAg, serum alanine aminotransferase level, and liver cirrhosis.