Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Liver Int. 2016 Dec;36(12):1793-1799. doi: 10.1111/liv.13179. Epub 2016 Jun 28.
BACKGROUND & AIMS: Patients with chronic hepatitis C (CHC) after successful antiviral therapy remain at risk of hepatocellular carcinoma (HCC). This study was to determine whether liver stiffness measurement (LSM) was useful in HCC risk assessment and to develop a risk-score system for clinical use.
This retrospective study enrolled patients with CHC achieving sustained virological response (SVR) after interferon-based therapy with LSM at/after SVR determination. The demographics, clinical characteristics and HCC development were obtained from medical chart reviews. The diagnosis of HCC was based on recommended criteria.
A total of 376 (M/F: 185/191, mean age: 54.1 years) patients, including 278 with pretreatment liver biopsy specimens, with a median follow-up period of 7.6 years were enrolled. Twenty-one patients developed HCC. The 5- and 10-year cumulative HCC incidences were 1.4% and 7.8%, respectively. Multivariate analysis showed advanced fibrosis/cirrhosis, diabetes and LSM were associated with HCC developments with odds ratio (OR) of 12.38, 2.80 and 1.01, respectively. For LSM in HCC prediction, the performance and cut-off were 0.783 and 12 kilopascal (kPa), respectively. For 278 patients with pretreatment biopsy, a risk-score system (score 0-4) combining advanced fibrosis/cirrhosis, diabetes and LSM >12 kPa was developed. With the low-risk group as a reference, patients in intermediate- (OR: 12.57) and high-risk (OR: 197.33) groups carried higher risk of HCC development.
For patients with CHC achieving SVR, liver stiffness value at/after SVR determination was associated with HCC development independently. Patients with pretreatment advanced fibrosis/cirrhosis, diabetes and LSM >12 kPa after SVR were at high risk of HCC development.
慢性丙型肝炎（CHC）患者在成功接受抗病毒治疗后仍有发生肝细胞癌（HCC）的风险。本研究旨在确定肝硬度测量（LSM）是否有助于 HCC 风险评估，并为临床应用开发风险评分系统。
本回顾性研究纳入了接受干扰素为基础的治疗后获得持续病毒学应答（SVR）并在 SVR 确定后进行 LSM 的 CHC 患者。从病历回顾中获取人口统计学、临床特征和 HCC 发展情况。HCC 的诊断基于推荐标准。
共纳入 376 例（男/女：185/191，平均年龄：54.1 岁）患者，包括 278 例有预处理肝活检标本，中位随访时间为 7.6 年。21 例患者发生 HCC。5 年和 10 年累积 HCC 发生率分别为 1.4%和 7.8%。多变量分析显示，晚期纤维化/肝硬化、糖尿病和 LSM 与 HCC 发展相关，比值比（OR）分别为 12.38、2.80 和 1.01。对于 LSM 在 HCC 预测中的表现和截断值分别为 0.783 和 12 千帕斯卡（kPa）。对于 278 例有预处理活检的患者，建立了一个结合晚期纤维化/肝硬化、糖尿病和 LSM>12kPa 的风险评分系统（评分 0-4）。以低风险组为参照，中风险组（OR：12.57）和高风险组（OR：197.33）患者 HCC 发生风险更高。
对于 CHC 患者，在 SVR 后进行 LSM 测量与 HCC 发展独立相关。对于 SVR 后具有预处理晚期纤维化/肝硬化、糖尿病和 LSM>12kPa 的患者，HCC 发生风险较高。
