Risk of hepatocellular carcinoma after sustained virologic response in hepatitis C virus patients without advanced liver fibrosis
Risk of hepatocellular carcinoma after sustained virologic response in hepatitis C virus patients without advanced liver fibrosis
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无晚期肝纤维化的丙型肝炎病毒患者持续病毒学应答后发生肝细胞癌的风险
DOI：
10.1111/hepr.13806
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发表时间：
2022
影响因子：
4.2
通讯作者：
et al.
中科院分区：
文献类型：
--
作者：
Tahata Yuki;Sakamori Ryotaro;Yamada Ryoko;et al.
目的观察到持续病毒学应答(SVR)后的肝细胞癌(HCC)，即使在无严重肝纤维化的丙型肝炎病毒(HCV)患者中也是如此。在无晚期肝纤维化的患者中确定肝癌发病率的预测因素将使SVR后肝细胞癌的有效监测成为可能。本研究旨在建立一种评分系统来预测无晚期肝纤维化的丙型肝炎患者SVR后肝细胞癌的发生率。方法纳入1682例无晚期肝纤维化(定义为纤维化-4指数3.25)的丙型肝炎患者，这些患者在2014年9月至2020年10月期间在26个机构开始直接作用抗病毒治疗，并获得SVR24。结果在多因素分析中，基线年龄≥为65岁(p=0.0.030)、血清丙氨酸氨基转移酶(ALT)水平在SVR24和≥为30U/L(p=0.001)、甲胎蛋白(α)水平在SVR24和≥为5.0 ng/ml(p=0.001)是训练队列中肝细胞癌发病的独立预测因素。我们开发了一个使用这三个因素(每个因素加1分)来预测SVR24术后肝细胞癌发病率的评分系统。在验证队列中得分为0的患者中，5年内累积的肝癌发病率为7.1%，而在验证队列中得分为0的患者中没有患者发生肝癌。结论我们的评分系统使用基线年龄、SVR时ALT水平和SVR时AFP水平这三个因素，对于无晚期肝纤维化的患者的SVR后肝细胞癌监测是有用的。
AimHepatocellular carcinoma (HCC) after sustained virologic response (SVR) has been observed even in hepatitis C virus (HCV) patients without advanced liver fibrosis. Identifying predictors for HCC incidence in patients without advanced liver fibrosis will enable efficient post‐SVR HCC surveillance. This study aimed to develop a scoring system to predict the incidence of HCC after SVR in HCV patients without advanced liver fibrosis.MethodsA total of 1682 HCV patients without advanced liver fibrosis (defined as Fibrosis‐4 index <3.25) with no history of HCC who initiated direct‐acting antiviral treatment between September 2014 and October 2020 at 26 institutions, and achieved SVR24, were included. We divided 1682 patients into training (1122) and validation (560) cohorts.ResultsIn the multivariate analysis, baseline age ≥ 65 years (p= 0.030), alanine aminotransferase (ALT) levels at SVR24 ≥ 30 U/l (p= 0.001), and α‐fetoprotein (AFP) levels at SVR24 ≥ 5.0 ng/ml (p= 0.001) were independent predictors for HCC incidence in the training cohort. We developed a scoring system to predict HCC incidence after SVR24 using these three factors (1 point was added for each factor). The cumulative HCC incidence rates at 5 years were 7.1% in patients who scored 2 or 3, and no patients developed HCC in those who scored 0 in the validation cohort.ConclusionsOur scoring system using the three factors of baseline age, ALT levels at SVR, and AFP levels at SVR is useful for post‐SVR HCC surveillance of patients without advanced liver fibrosis.