【原】【原創(chuàng)】J Hepatol：慢性乙型肝炎患者HBsAg血清清除后肝細胞癌的發(fā)生率：需要監(jiān)測

臨床肝膽病雜志 2019-12-13

展開全文

背景和目的

對于表面抗原血清清除的慢性乙型肝炎患者，是否該繼續(xù)監(jiān)測肝細胞癌的發(fā)生，這方面的研究很少。

方法

本研究是回顧性分析了1997-2012年韓國三級醫(yī)院的達到了表面抗原血清清除的829例患者（平均年齡52.3歲，575例男性，98例合并有肝硬化）。我們評估了肝癌的發(fā)生率并驗證了基于表面抗原血清清除時間點的CU-HCC肝癌風險評分。

結果

在3464隨訪人年中，19例患者發(fā)展為肝癌（年發(fā)生率為0.55%），在表面抗原血清清除的時間點，肝硬化、男性、年齡大于50，是肝細胞癌發(fā)生的獨立危險因素。預估有肝硬化和沒有肝硬化的乙肝患者每年肝癌發(fā)生率分別為2.85%和0.29%，在沒有肝硬化的患者中，男性患者發(fā)生肝癌的幾率大于女性，所有肝癌的發(fā)生在50歲以后。時間依賴的受試者特征曲線下面積的CU-HCC肝癌風險評分，對肝癌的5年及10年預測分別為0.85和0.74。

結論

即使獲得了表面抗原的血清清除，肝硬化患者及年齡大于50的男性非肝硬化患者，特別是C型HBV感染的患者，都需要監(jiān)測肝癌發(fā)生的可能。表面抗原清除發(fā)生的時間在50歲以后，也是肝細胞發(fā)生的獨立預測因素。

INCIDENCE OF HEPATOCELLULAR CARCINOMA AFTER HBSAG SEROCLEARANCE IN CHRONIC HEPATITIS B PATIENTS: A NEED FOR SURVEILLANCE.

BACKGROUND & AIMS:

Little is known about whether surveillance for hepatocellular carcinoma (HCC) is worthwhile in chronic hepatitis B virus (HBV)-infected patients who have achieved HBsAg seroclearance.

METHODS:

A retrospective analysis of 829 patients (mean age: 52.3years; 575 males; 98 with cirrhosis) achieving HBsAg seroclearance was performed at a tertiary hospital in Korea between 1997 and 2012. We evaluated incidence rates of HCC, and validated CU-HCC score based on data at the time of HBsAg seroclearance.

RESULTS:

During a follow-up of 3464 patient-years, 19 patients developed HCC (annual rate: 0.55%). Liver cirrhosis (hazard ratio [HR]: 10.80; 95% confidence interval [CI]: 4.25-27.43), male gender (HR: 8.96; 95% CI: 1.17-68.80), and age ?50years at the time of HBsAg seroclearance (HR: 12.14; 95% CI: 1.61-91.68) were independently associated with HCC. The estimated annual incidence of HCC was 2.85% and 0.29% in patients with and without cirrhosis, respectively. Among the non-cirrhotic patients, the annual rate of HCC was higher in the male patients than in the females (0.40% vs. 0%, respectively), and all the HCCs developed after age 50. The time-dependent area under the receiver operating characteristic curves for the CU-HCC score for 5year and 10year HCC prediction were 0.85 and 0.74, respectively.

CONCLUSIONS:

HCC surveillance should be considered for cirrhotic patients and non-cirrhotic male patients over age 50, even after HBsAg seroclearance, especially those infected with HBV genotype C. HBsAg seroclearance at age ?50years was also an independent predictor for HCC.