Guo Jiang, Gao Xue-Song
Department of Interventional Oncology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
Department of General Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
World J Clin Cases. 2021 May 16;9(14):3238-3251. doi: 10.12998/wjcc.v9.i14.3238.
Chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC) is a major health problem in Asian-Pacific regions. Antiviral therapy reduces, but does not completely prevent, HCC development. Thus, there is a need for accurate risk prediction to assist prognostication and decisions on the need for antiviral therapy and HCC surveillance. A few risk scores have been developed to predict the occurrence of HCC in CHB patients. Initially, the scores were derived from untreated CHB patients. With the development and extensive clinical application of nucleos(t)ide analog(s) (NA), the number of risk scores based on treated CHB patients has increased gradually. The components included in risk scores may be categorized into host factors and hepatitis B virus factors. Hepatitis activities, hepatitis B virus factors, and even liver fibrosis or cirrhosis are relatively controlled by antiviral therapy. Therefore, variables that are more dynamic during antiviral therapy have since been included in risk scores. However, host factors are more difficult to modify. Most existing scores derived from Asian populations have been confirmed to be accurate in predicting HCC development in CHB patients from Asia, while these scores have not offered excellent predictability in Caucasian patients. These findings support that more relevant variables should be considered to provide individualized predictions that are easily applied to CHB patients of different ethnicities. CHB patients should receive different intensities of HCC surveillance according to their risk category.
慢性乙型肝炎（CHB）相关肝细胞癌（HCC）是亚太地区的一个主要健康问题。抗病毒治疗可降低但不能完全预防HCC的发生。因此，需要准确的风险预测来辅助预后评估以及对抗病毒治疗需求和HCC监测的决策。已经开发了一些风险评分来预测CHB患者中HCC的发生。最初，这些评分是从不治的CHB患者中得出的。随着核苷（酸）类似物（NA）的发展和广泛临床应用，基于接受治疗的CHB患者的风险评分数量逐渐增加。风险评分中包含的成分可分为宿主因素和乙型肝炎病毒因素。肝炎活动度、乙型肝炎病毒因素，甚至肝纤维化或肝硬化通过抗病毒治疗可得到相对控制。因此，抗病毒治疗期间更具动态变化的变量此后被纳入风险评分中。然而，宿主因素更难改变。大多数源自亚洲人群的现有评分已被证实能准确预测亚洲CHB患者中HCC的发生，而这些评分在白种人患者中并未提供出色的预测能力。这些发现支持应考虑更多相关变量以提供易于应用于不同种族CHB患者的个性化预测。CHB患者应根据其风险类别接受不同强度的HCC监测。
