Lee Jae Seung, Lee Hyun Woong, Lim Tae Seop, Min In Kyung, Lee Hye Won, Kim Seung Up, Park Jun Yong, Kim Do Young, Ahn Sang Hoon, Kim Beom Kyung
Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea.
Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea.
Cancers (Basel). 2022 Jan 29;14(3):711. doi: 10.3390/cancers14030711.
Antiviral therapy (AVT) induces the regression of non-invasive fibrosis markers (NFMs) and reduces hepatocellular carcinoma (HCC) risk among chronic hepatitis B (CHB) patients. We externally validated the predictive performance of the FSAC prediction model for HCC using on-therapy NFM responses. Our multicenter study consecutively recruited treatment-naïve CHB patients ( = 3026; median age, 50.0 years; male predominant (61.3%); cirrhosis in 1391 (46.0%) patients) receiving potent AVTs for >18 months between 2007 and 2018. During follow-up (median 64.0 months), HCC developed in 303 (10.0%) patients. Patients with low FIB-4 or APRI levels at 12 months showed significantly lower HCC risk than those with high NFM levels at 12 months (all < 0.05). Cumulative 3-, 5-, and 8-year HCC probabilities were 0.0%, 0.3% and 1.2% in the low-risk group (FSAC ≤ 2); 2.1%, 5.2%, and 11.1% in the intermediate-risk group (FSAC 3-8); and 5.2%, 15.5%, and 29.8% in the high-risk group (FSAC ≥ 9) (both < 0.001 between each adjacent pair). Harrell's c-index value for FSAC score (0.770) was higher than those for PAGE-B (0.725), modified PAGE-B (0.738), modified REACH-B (0.737), LSM-HCC (0.734), and CAMD (0.742). Our study showed that the FSAC model, which incorporates on-therapy changes in NFMs, had better predictive performance than other models using only baseline parameters.
抗病毒治疗（AVT）可促使慢性乙型肝炎（CHB）患者的非侵入性纤维化标志物（NFM）消退，并降低肝细胞癌（HCC）风险。我们利用治疗期间的NFM反应，对外验证了FSAC预测模型对HCC的预测性能。我们的多中心研究连续招募了2007年至2018年间接受强效AVT治疗超过18个月的初治CHB患者（n = 3026；中位年龄50.0岁；男性占主导（61.3%）；1391例（46.0%）患者有肝硬化）。在随访期间（中位64.0个月），303例（10.0%）患者发生了HCC。在12个月时FIB-4或APRI水平低的患者，其HCC风险显著低于12个月时NFM水平高的患者（均P < 0.05）。低风险组（FSAC≤2）的3年、5年和8年累积HCC发生率分别为0.0%、0.3%和1.2%；中风险组（FSAC 3 - 8）分别为2.1%、5.2%和11.1%；高风险组（FSAC≥9）分别为5.2%、15.5%和29.8%（每相邻两组之间均P < 0.001）。FSAC评分的Harrell's c指数值（0.770）高于PAGE - B（0.725）、改良PAGE - B（0.738）、改良REACH - B（0.737）、LSM - HCC（0.734）和CAMD（0.742）。我们的研究表明，纳入治疗期间NFM变化的FSAC模型比仅使用基线参数的其他模型具有更好的预测性能。
