Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
J Viral Hepat. 2019 Dec;26(12):1465-1472. doi: 10.1111/jvh.13185. Epub 2019 Aug 13.
We assessed the incidence of hepatocellular carcinoma (HCC) in those outside of current treatment recommendations and risk factors associated with HCC development. A multi-centre, retrospective cohort of 3624 patients who were monitored without antiviral treatment was analysed. Incident HCC risk according to the Asian Pacific Association for the study of the Liver (APASL), the American Association for the Study of Liver Disease (AASLD) and the European Association for the Study of the Liver (EASL) treatment recommendations was assessed. A risk score was developed using independent factors associated with HCC development among patients who were outside current treatment criteria. During a median follow-up of 4.6 years, incident HCC was diagnosed in 161 (4.4%) patients. The proportions of patients who developed HCC outside treatment recommendation according to APASL, AASLD and EASL criteria were 64.0%, 46.0% and 33.5%, respectively. The 5-year cumulative HCC incidence rate was 13.9% for cirrhotic patients with low-level viremia and 6.1 ~ 7.3% for chronic hepatitis patients with elevated HBV DNA levels plus mildly elevated alanine aminotransferase levels. Among patients who were outside treatment recommendation, age, sex, hepatitis B e antigen, cirrhosis, alanine aminotransferase and platelet levels were independent factors associated with HCC development. When these factors were used to calculate the risk score for each patient, those with a score ≥8 had a higher HCC incidence rate (14.3% at 5-year), although they were currently outside treatment recommendations. Thus, HCC was observed among patients who were outside current treatment criteria indicating that careful monitoring for HCC and efforts to identify patients at risk are required.
我们评估了不符合当前治疗建议和与 HCC 发展相关的危险因素的患者中肝细胞癌（HCC）的发病率。分析了 3624 名未接受抗病毒治疗的患者的多中心回顾性队列。根据亚太肝病研究学会（APASL）、美国肝病研究学会（AASLD）和欧洲肝病研究学会（EASL）的治疗建议评估了符合 HCC 风险的患者比例。使用不符合当前治疗标准的患者中与 HCC 发展相关的独立因素开发了风险评分。在中位随访 4.6 年后，161 名（4.4%）患者诊断为 HCC。根据 APASL、AASLD 和 EASL 标准，不符合治疗建议的患者发生 HCC 的比例分别为 64.0%、46.0%和 33.5%。对于低病毒血症的肝硬化患者，5 年累积 HCC 发生率为 13.9%，对于 HBV DNA 水平升高伴丙氨酸氨基转移酶水平轻度升高的慢性乙型肝炎患者，5 年累积 HCC 发生率为 6.1%至 7.3%。在不符合治疗建议的患者中，年龄、性别、乙型肝炎 e 抗原、肝硬化、丙氨酸氨基转移酶和血小板水平是与 HCC 发展相关的独立因素。当这些因素用于计算每个患者的风险评分时，评分≥8 的患者 HCC 发生率更高（5 年时为 14.3%），尽管他们目前不符合治疗建议。因此，在符合当前治疗标准的患者中观察到 HCC，这表明需要对 HCC 进行仔细监测并努力识别有风险的患者。
