Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Cancer Epidemiol Biomarkers Prev. 2020 Apr;29(4):832-837. doi: 10.1158/1055-9965.EPI-19-0614. Epub 2020 Jan 27.
Long-term antiviral therapy (AVT) for chronic hepatitis B (CHB) reduces the risk of hepatocellular carcinoma (HCC). We assessed the temporal trends in the incidence of HCC over time during long-term AVT among Asian patients with CHB.
Patients with CHB receiving entecavir/tenofovir (ETV/TDF) as a first-line antiviral were recruited from four academic hospitals in the Republic of Korea. We compared the incidence of HCC during and after the first 5 years of ETV/TDF treatment.
Among 3,156 patients, the median age was 49.6 years and males predominated (62.4%). During the follow-up, 9.0% developed HCC. The annual incidence of HCC per 100 person-years during the first 5 years ( = 1,671) and after the first 5 years ( = 1,485) was statistically similar (1.93% vs. 2.27%, = 0.347). When the study population was stratified according to HCC prediction model, that is, modified PAGE-B score, the annual incidence of HCC was 0.11% versus 0.39% in the low-risk group (<8 points), 1.26% versus 1.82% in the intermediate-risk group (9-12 points), and 4.63% versus 5.24% in the high-risk group (≥13 points; all > 0.05). A Poisson regression analysis indicated that the duration of AVT did not significantly affect the overall trend of the incidence of HCC (adjusted annual incidence rate ratio = 0.85; 95% confidence interval, 0.66-1.11; = 0.232).
Despite long-term AVT, the risk of HCC steadily persists over time among patients with CHB in the Republic of Korea, in whom HBV genotype C2 predominates.
Careful HCC surveillance is still essential.
长期抗病毒治疗（AVT）可降低慢性乙型肝炎（CHB）患者发生肝细胞癌（HCC）的风险。我们评估了韩国的 CHB 患者在接受恩替卡韦/替诺福韦（ETV/TDF）一线抗病毒治疗期间，随着时间推移 HCC 发病率的变化趋势。
从韩国的四家学术医院招募接受 ETV/TDF 治疗的 CHB 患者。我们比较了 ETV/TDF 治疗前 5 年和治疗后的 HCC 发病率。
3156 例患者中，中位年龄为 49.6 岁，男性占多数（62.4%）。随访期间，9.0%的患者发生 HCC。前 5 年每 100 人年 HCC 发病率（ = 1671）和第 5 年后的发病率（ = 1485）无统计学差异（1.93%比 2.27%， = 0.347）。当按 HCC 预测模型（即改良 PAGE-B 评分）对研究人群进行分层时，低危组（<8 分）的 HCC 年发病率为 0.11%，中危组（9-12 分）为 1.26%，高危组（≥13 分）为 4.63%，均无统计学差异（均 > 0.05）。泊松回归分析表明，AVT 持续时间并未显著影响 HCC 发病率的整体趋势（调整后年发病率比 = 0.85；95%置信区间，0.66-1.11； = 0.232）。
尽管长期抗病毒治疗，但在韩国，HBV 基因型 C2 占优势的 CHB 患者中，随着时间推移 HCC 的风险仍持续存在。
仍需密切监测 HCC。
