Yuen Man-Fung, Tanaka Yasuhito, Fong Daniel Yee-Tak, Fung James, Wong Danny Ka-Ho, Yuen John Chi-Hang, But David Yiu-Kuen, Chan Annie On-On, Wong Benjamin Chun-Yu, Mizokami Masashi, Lai Ching-Lung
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.
J Hepatol. 2009 Jan;50(1):80-8. doi: 10.1016/j.jhep.2008.07.023. Epub 2008 Sep 21.
BACKGROUND/AIMS: To determine whether gender, age, hepatitis B virus genotype, core promoter and precore mutations, HBeAg/ anti-HBe status, HBV DNA, ALT levels and cirrhosis on presentation were independent risk factors and derive a novel risk score for the development of HCC.
CHB patients (820) were followed up (mean duration 76.8 months) for the occurrence of HCC.
The 5- and 10-year prevalence of HCC were 4.4% and 6.3%, respectively. Cox regression analysis showed that male gender (p = 0.025, RR 2.98), increasing age (p < 0.001, RR 1.07), higher HBV DNA levels (p = 0.02, RR 1.28), core promoter mutations (p = 0.007, RR 3.66), and presence of cirrhosis (p < 0.001, RR 7.31) were independent risks for the development of HCC. A risk score was derived and validated with sensitivity > 84% and specificity > 76% to predict the 5- and 10- year risks for the development of HCC. The AUC for the 5- and 10-year prediction were 0.88 and 0.89, respectively.
The risk score, based on age, gender, HBV DNA levels, core promoter mutations and cirrhosis, can estimate the chance of development of HCC in 5 and 10 years after presentation. It can be used to identify high-risk CHB patients for treatment and screening of HCC.
背景/目的：确定性别、年龄、乙型肝炎病毒基因型、核心启动子和前核心突变、HBeAg/抗-HBe状态、HBV DNA、就诊时的ALT水平和肝硬化是否为肝细胞癌（HCC）发生的独立危险因素，并得出预测HCC发生的新风险评分。
对820例慢性乙型肝炎（CHB）患者进行随访（平均随访时间76.8个月），观察HCC的发生情况。
HCC的5年和10年患病率分别为4.4%和6.3%。Cox回归分析显示，男性（p = 0.025，风险比[RR] 2.98）、年龄增加（p < 0.001，RR 1.07）、较高的HBV DNA水平（p = 0.02，RR 1.28）、核心启动子突变（p = 0.007，RR 3.66）和肝硬化的存在（p < 0.001，RR 7.31）是HCC发生的独立危险因素。得出了一个风险评分，并进行了验证，其预测HCC发生5年和10年风险的敏感度> 84%，特异度> 76%。5年和10年预测的受试者工作特征曲线下面积（AUC）分别为0.88和0.89。
基于年龄、性别、HBV DNA水平、核心启动子突变和肝硬化的风险评分可估计就诊后5年和10年发生HCC的可能性。它可用于识别需要治疗和进行HCC筛查的高风险CHB患者。
