Li Zhiqin, Hu Yushu, Wang Hongyan, Wang Meng, Gu Xinyu, Ping Yu, Zeng Qinglei, Li Hua, Yan Jingya, Yu Zujiang
Department of Infectious Disease.
Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University.
Eur J Gastroenterol Hepatol. 2020 Mar;32(3):447-453. doi: 10.1097/MEG.0000000000001631.
Patients diagnosed with hepatitis B virus (HBV)-related hepatic cirrhosis have the potential for progression to hepatocellular carcinoma (HCC) even while undergoing long-term nucleos(t)ide analog (NA) therapy. This study investigated the predictors for the progression of hepatic cirrhosis to HCC under long-term NA therapy.
This retrospective study enrolled 898 patients diagnosed with HBV-related hepatic cirrhosis. They received NA therapy between January 2012 and January 2015. The values for the liver stiffness measurement (LSM), laboratory tests, and disease history were collected. The diagnostic specificity of the serum, was assessed with a receiver operating characteristic curve.
The overall 2- and 3-year cumulative incidence of HCC was 6.8% and 15.15%, respectively. The LSM values were higher in the patients who had progressed to HCC. The serum PIVKA-II levels were more efficient than the serum AFP levels for the diagnosis of early HCC as the larger area under curve (0.866 vs. 0.687). The multivariate logistic regression analysis showed that HCC occurrence was significantly associated with the baseline LSM value (odds ratio = 1.035). At the end of the study, the death rate for the patients with larger LSM values was higher than that for those with lower LSM values (67.88% vs. 39.90%).
Patients with HBV-related cirrhosis have the potential for progression to HCC even under long-term NA therapy. The LSM value and the serum PIVKA-II level are significant predictors of HCC occurrence.
被诊断为乙型肝炎病毒（HBV）相关肝硬化的患者，即便接受长期核苷（酸）类似物（NA）治疗，仍有进展为肝细胞癌（HCC）的可能。本研究调查了长期NA治疗下肝硬化进展为HCC的预测因素。
这项回顾性研究纳入了898例被诊断为HBV相关肝硬化的患者。他们在2012年1月至2015年1月期间接受了NA治疗。收集了肝脏硬度测量（LSM）值、实验室检查结果和疾病史。用受试者工作特征曲线评估血清的诊断特异性。
HCC的总体2年和3年累积发病率分别为6.8%和15.15%。进展为HCC的患者LSM值更高。血清异常凝血酶原-II（PIVKA-II）水平在早期HCC诊断中比血清甲胎蛋白（AFP）水平更有效，曲线下面积更大（0.866对0.687）。多因素逻辑回归分析显示，HCC发生与基线LSM值显著相关（比值比=1.035）。在研究结束时，LSM值较高的患者死亡率高于LSM值较低的患者（67.88%对39.90%）。
HBV相关肝硬化患者即使在长期NA治疗下也有进展为HCC的可能。LSM值和血清PIVKA-II水平是HCC发生的重要预测因素。
