Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
Scand J Gastroenterol. 2022 Jan;57(1):70-77. doi: 10.1080/00365521.2021.1988700. Epub 2021 Nov 3.
Some young adults with chronic hepatitis B virus (HBV) infection might be at high risk for hepatocellular carcinoma (HCC), enough to justify regular HCC surveillance despite the young age of the patients. However, ways to identify at-risk individuals who may benefit from HCC surveillance need further evaluations.
A hospital-based retrospective cohort of 2757 chronic HBV mono-infected young adults (median age: 34 years, males 66%) were analyzed. The primary outcome was young-onset HCC, defined as a diagnosis made under 40 years of age. We calculated the HCC incidence/1000 person-years in the overall cohort and pre-defined subgroups of patients assessed the independent risk factors that can be used to identify surveillance targets.
The HCC incidence was low (2.55/1000 person-years) in the overall cohort. However, the HCC incidence varied widely according to baseline characteristics: lowest among young adults with FIB-4 ≤ 0.70 (0.17/1000 person-years) and highest in young adults with radiological cirrhosis (30.7/1000 person-years). In multivariable analysis, radiological cirrhosis, the FIB-4 index, and serum HBV DNA level were independent factors associated with HCC development at a young age. Performance for prediction of young-onset HCC in radiological cirrhotic patients showed the highest specificity but sensitivity was <70%. Combination with FIB-4 index and HBV DNA levels increased sensitivity to 90%.
Risk stratification using FIB-4 index, HBV DNA levels, and either combining radiological cirrhosis or gender and AFP levels would be helpful to stratify young patients who would and would not benefit from regular HCC surveillance.
一些患有慢性乙型肝炎病毒 (HBV) 感染的年轻成年人可能存在较高的肝细胞癌 (HCC) 风险，足以证明尽管患者年龄较小，但仍需要定期进行 HCC 监测。然而，需要进一步评估识别可能受益于 HCC 监测的高危个体的方法。
对 2757 名慢性 HBV 单感染的年轻成年人（中位年龄：34 岁，男性占 66%）进行了一项基于医院的回顾性队列研究。主要结局为青年期 HCC，定义为 40 岁以下诊断的 HCC。我们计算了整个队列和预先定义的患者亚组的 HCC 发病率/1000 人年，并评估了可用于识别监测目标的独立危险因素。
整个队列的 HCC 发病率较低（2.55/1000 人年）。然而，根据基线特征，HCC 发病率差异很大：FIB-4≤0.70 的年轻成年人发病率最低（0.17/1000 人年），影像学肝硬化的年轻成年人发病率最高（30.7/1000 人年）。多变量分析显示，影像学肝硬化、FIB-4 指数和血清 HBV DNA 水平是与年轻患者 HCC 发展相关的独立因素。在影像学肝硬化患者中，预测青年 HCC 的表现特异性最高，但敏感性<70%。与 FIB-4 指数和 HBV DNA 水平相结合可将敏感性提高至 90%。
使用 FIB-4 指数、HBV DNA 水平以及影像学肝硬化或性别和 AFP 水平进行风险分层有助于分层需要和不需要定期 HCC 监测的年轻患者。
