Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Department of Public Health, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.
Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France.
Clin Res Hepatol Gastroenterol. 2021 Sep;45(5):101713. doi: 10.1016/j.clinre.2021.101713. Epub 2021 Apr 27.
BACKGROUND & AIMS: The factors predicting hepatocellular carcinoma (HCC) occurrence in chronic hepatitis B need to be precisely known to improve its detection. We identified pathways and individual predictive factors associated with HCC in the ANRS CO22 HEPATHER cohort.
The study analyzed HBV-infected patients recruited at 32 French expert hepatology centers from August 6, 2012, to December 31, 2015. We excluded patients with chronic HCV, HDV and a history of HCC, decompensated cirrhosis or liver transplantation. Structural equation models were developed to characterize the causal pathways leading to HCC occurrence. The association between clinical characteristics (age, gender, body-mass index, liver fibrosis, alcohol consumption, smoking status, diabetes, hypertension, dyslipidemia, alpha-fetoprotein, HBV DNA levels, antiviral therapy) and incident HCC was quantified.
Among the 4489 patients included, 33 patients reported incident HCC. The median follow-up was 45.5 months. Age (β = 0.18 by decade, 95% CI 0.14-0.23), male gender (β = 0.23, 95% CI 0.18-0.29), metabolic syndrome (β = 0.28, 95% CI 0.22-0.33), alcohol consumption (β = 0.09, 95% CI 0.05-0.14) and HBV DNA (β = 0.25, 95% CI 0.170.34) had a significant and direct effect on the occurrence of advanced liver fibrosis. Liver fibrosis (β = 0.71, 95% CI 0.55-0.87) predicted, in turn, the occurrence of HCC.
Liver fibrosis mediates the effects of age, gender, alcohol, metabolic syndrome and HBV DNA on the occurrence of HCC. Elderly men with chronic hepatitis B, risky alcohol use, advanced liver fibrosis, metabolic syndrome and high HBV DNA levels should be monitored closely to detect the development of HCC.
为了提高肝癌（HCC）的检出率，需要准确了解预测慢性乙型肝炎发生 HCC 的因素。我们在法国 ANRS CO22 HEPATHER 队列中确定了与 HCC 相关的途径和个体预测因素。
该研究分析了 2012 年 8 月 6 日至 2015 年 12 月 31 日在 32 家法国专家级肝病中心招募的 HBV 感染患者。我们排除了慢性 HCV、HDV 和 HCC 病史、失代偿性肝硬化或肝移植的患者。采用结构方程模型来描述导致 HCC 发生的因果途径。定量分析临床特征（年龄、性别、体重指数、肝纤维化、饮酒、吸烟状况、糖尿病、高血压、血脂异常、甲胎蛋白、HBV DNA 水平、抗病毒治疗）与 HCC 发病的关系。
在纳入的 4489 例患者中，有 33 例患者报告发生 HCC。中位随访时间为 45.5 个月。年龄（每十年增加 0.18，95%CI 0.14-0.23）、男性（β=0.23，95%CI 0.18-0.29）、代谢综合征（β=0.28，95%CI 0.22-0.33）、饮酒（β=0.09，95%CI 0.05-0.14）和 HBV DNA（β=0.25，95%CI 0.17-0.34）对进展性肝纤维化的发生有显著且直接的影响。肝纤维化（β=0.71，95%CI 0.55-0.87）依次预测 HCC 的发生。
肝纤维化介导年龄、性别、酒精、代谢综合征和 HBV DNA 对 HCC 发生的影响。患有慢性乙型肝炎的老年男性、有风险的饮酒、进展性肝纤维化、代谢综合征和高 HBV DNA 水平的患者应密切监测，以检测 HCC 的发展。
