Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Br J Cancer. 2013 Oct 29;109(9):2481-8. doi: 10.1038/bjc.2013.564. Epub 2013 Oct 1.
Interferon (IFN)-based therapies could eradicate hepatitis C (HCV) and reduce the risk of hepatocellular carcinoma (HCC). However, HCC could still happen after sustained virological response (SVR). We aimed to develop a simple scoring system to predict the risk of HCC development among HCV patients after antiviral therapies.
From 1999 to 2009, 1879 patients with biopsy-proven HCV infection treated with IFN-based therapies were analyzed.
Multivariable analysis showed old age (adjusted HR (aHR)=1.73, 95% CI=1.13-2.65 for aged 60-69 and aHR=2.20, 95% CI=1.43-3.37 for aged ≥ 70), Male gender (aHR=1.74, 95% CI=1.26-2.41), platelet count <150 × 10(9)/l (HR=1.91, 95% CI=1.27-2.86), α-fetoprotein ≥ 20 ng ml(-1) (HR=2.23, 95% CI=1.58-3.14), high fibrotic stage (HR=3.32, 95% CI=2.10-5.22), HCV genotype 1b (HR=1.53, 95% CI=1.10-2.14), and non SVR (HR=2.40, 95% CI=1.70-3.38) were independent risk factors for HCC. Regression coefficients were used to build up a risk score and the accuracy was evaluated by using the area under the receiver operating characteristic curve (AUC). Three groups as low-, intermediate-, and high-risk are classified based on the risk scores. One hundred sixty patients (12.78%) in the derivation and 82 patients (13.08%) in the validation cohort developed HCC with AUC of 79.4%, sensitivity of 84.38%, and specificity of 60.66%. In the validation cohort, the 5-year HCC incidence was 1.81%, 12.92%, and 29.95% in low-, intermediate-, and high-risk groups, with hazard ratios 4.49 in intermediate- and 16.14 in high-risk group respectively. The risk reduction of HCC is greatest in patients with SVR, with a 5-year and 10-year risk reduction of 28.91% and 27.99% respectively.
The risk scoring system is accurate in predicting HCC development for HCV patients after antiviral therapies.
基于干扰素的治疗可以清除丙型肝炎（HCV）并降低肝细胞癌（HCC）的风险。然而，在持续病毒学应答（SVR）后，HCC 仍可能发生。我们旨在开发一种简单的评分系统，以预测接受抗病毒治疗的 HCV 患者 HCC 发展的风险。
从 1999 年到 2009 年，分析了 1879 例经 IFN 治疗的活检证实的 HCV 感染患者。
多变量分析显示，年龄较大（调整后的 HR（aHR）=1.73，95%CI=1.13-2.65 岁；aHR=2.20，95%CI=1.43-3.37 岁），男性（aHR=1.74，95%CI=1.26-2.41），血小板计数<150×10(9)/l（HR=1.91，95%CI=1.27-2.86），α-胎蛋白≥20ng/ml（HR=2.23，95%CI=1.58-3.14），高纤维化阶段（HR=3.32，95%CI=2.10-5.22），HCV 基因型 1b（HR=1.53，95%CI=1.10-2.14）和非 SVR（HR=2.40，95%CI=1.70-3.38）是 HCC 的独立危险因素。使用回归系数构建风险评分，并使用接收器工作特征曲线（AUC）下的面积评估准确性。根据风险评分将低、中、高危分为三组。在推导队列中有 160 例（12.78%）患者和验证队列中有 82 例（13.08%）患者发生 HCC，AUC 为 79.4%，灵敏度为 84.38%，特异性为 60.66%。在验证队列中，低、中、高危组的 5 年 HCC 发生率分别为 1.81%、12.92%和 29.95%，中间组的风险比为 4.49，高危组为 16.14。SVR 患者 HCC 风险降低最大，5 年和 10 年的风险降低分别为 28.91%和 27.99%。
该风险评分系统可准确预测接受抗病毒治疗的 HCV 患者 HCC 的发生。
