Park Jiyoon, Le An K, Tseng Tai-Chung, Yeh Ming-Lun, Jun Dae Won, Trinh Huy, Wong Grace L H, Chen Chien-Hung, Peng Cheng-Yuan, Kim Sung Eun, Oh Hyunwoo, Kwak Min-Sun, Cheung Ka Shing, Toyoda Hidenori, Hsu Yao-Chun, Jeong Jae Yoon, Yoon Eileen L, Ungtrakul Teerapat, Zhang Jian, Xie Qing, Ahn Sang Bong, Enomoto Masaru, Shim Jae-Jun, Cunningham Chris, Jeong Soung Won, Cho Yong Kyun, Ogawa Eiichi, Huang Rui, Lee Dong-Hyun, Takahashi Hirokazu, Tsai Pei-Chien, Huang Chung-Feng, Dai Chia-Yen, Tseng Cheng-Hao, Yasuda Satoshi, Kozuka Ritsuzo, Li Jiayi, Wong Christopher, Wong Clifford C, Zhao Changqing, Hoang Joseph, Eguchi Yuichiro, Wu Chao, Tanaka Yasuhito, Gane Ed, Tanwandee Tawesak, Cheung Ramsey, Yuen Man-Fung, Lee Hyo-Suk, Yu Ming-Lung, Kao Jia-Horng, Yang Hwai-I, Nguyen Mindie H
Department of Medicine, Santa Clara Valley Medical Center, Santa Clara, California; Division of Gastroenterology and Hepatology, Stanford University Medical Center, California.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, California.
Clin Gastroenterol Hepatol. 2022 Apr;20(4):874-885.e4. doi: 10.1016/j.cgh.2021.05.062. Epub 2021 Jun 2.
BACKGROUND & AIMS: Antiviral treatment criteria are based on disease progression risk, and hepatocellular carcinoma (HCC) surveillance recommendations for patients with chronic hepatitis B (CHB) without cirrhosis is based on an annual incidence threshold of 0.2%. However, accurate and precise disease progression estimate data are limited. Thus, we aimed to determine rates of cirrhosis and HCC development stratified by age, sex, treatment status, and disease activity based on the 2018 American Association for the Study of Liver Diseases and 2017 European Association for the Study of the Liver guidelines.
We analyzed 18,338 patients (8914 treated, 9424 untreated) from 6 centers from the United States and 27 centers from Asia-Pacific countries. The Kaplan-Meier method was used to estimate annual progression rates to cirrhosis or HCC in person-years.
The cohort was 63% male, with a mean age of 46.19 years, with baseline cirrhosis of 14.3% and median follow up of 9.60 years. By American Association for the Study of Liver Diseases criteria, depending on age, sex, and disease activity, annual incidence rates ranged from 0.07% to 3.94% for cirrhosis, from 0.04% to 2.19% for HCC in patients without cirrhosis, and from 0.40% to 8.83% for HCC in patients with cirrhosis. Several subgroups of patients without cirrhosis including males younger than 40 years of age and females younger than 50 years of age had annual HCC risk near or exceeding 0.2%. Similar results were found using European Association for the Study of the Liver criteria.
There is great variability in CHB disease progression rates even among "lower-risk" populations. Future CHB modeling studies, public health planning, and HCC surveillance recommendation should be based on more precise disease progression rates based on sex, age, and disease activity, plus treatment status.
抗病毒治疗标准基于疾病进展风险，而对于无肝硬化的慢性乙型肝炎（CHB）患者，肝细胞癌（HCC）监测建议基于0.2%的年发病率阈值。然而，准确且精确的疾病进展估计数据有限。因此，我们旨在根据2018年美国肝病研究协会和2017年欧洲肝病研究协会的指南，确定按年龄、性别、治疗状态和疾病活动分层的肝硬化和HCC发生率。
我们分析了来自美国6个中心和亚太国家27个中心的18338例患者（8914例接受治疗，9424例未接受治疗）。采用Kaplan-Meier方法以人年为单位估计肝硬化或HCC的年进展率。
该队列中男性占63%，平均年龄为46.19岁，基线肝硬化发生率为14.3%，中位随访时间为9.60年。根据美国肝病研究协会的标准，取决于年龄、性别和疾病活动，肝硬化的年发病率范围为0.07%至3.94%，无肝硬化患者的HCC年发病率为0.04%至2.19%，有肝硬化患者的HCC年发病率为0.40%至8.83%。几个无肝硬化的患者亚组，包括年龄小于40岁的男性和年龄小于50岁的女性，其HCC年风险接近或超过0.2%。使用欧洲肝病研究协会的标准也发现了类似结果。
即使在“低风险”人群中，CHB疾病进展率也存在很大差异。未来的CHB建模研究、公共卫生规划和HCC监测建议应基于更精确的疾病进展率，该进展率基于性别、年龄、疾病活动以及治疗状态。
