Hangzhou Sixth People's Hospital / Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, 2 Hengbu Road, Hangzhou 310023, China.
Hangzhou Sixth People's Hospital / Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, 2 Hengbu Road, Hangzhou 310023, China.
Clin Res Hepatol Gastroenterol. 2022 Jun-Jul;46(6):101930. doi: 10.1016/j.clinre.2022.101930. Epub 2022 Apr 20.
The risk prediction of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) is a challenge especially in the era of antiviral therapy. The aim of this meta-analysis was to comprehensively evaluate the performance of existing HCC prediction scores in HCC prediction on antivirals.
We searched PubMed, Web of Science and Cochrane Library for relevant prospective studies from the inception to August 24, 2021. The areas under the receiver operating characteristics (AUROCs) and their relevant 95% confidence intervals (CIs) of the risk prediction models were calculated.
Nine eligible articles with 21561 patients (HCC developed in 947patients, 4.39%; mean follow-up duration: 5 years) and 14 predictive risk scores were included. The pooled AUROC of all included scores for 3-year and 5-year prediction of HCC was 0.72 (95%CI 0.68-0.76) and 0.80 (95%CI 0.76-0.83), with the corresponding sensitivity of 0.84 (95% CI 0.71-0.92) and 0.91(95% CI 0.86-0.95) and specificity of 0.46 (95% CI 0.30-0.63) and 0.48 (95% CI 0.37-0.59), respectively. All the 14 prediction models, as a whole, performed well in different populations, whether they include factor cirrhotic status or not; while those integrated viral load were less accurate (sensitivity 0.78, specificity of 0.57).
In patients with CHB on antivirals, the scores included in our meta-analysis have been proven to be useful for mid-long term HCC prediction. Viral load seems not useful, whereas cirrhosis and its objective surrogates remain the predominant components. These models are expected to translate clinical benefits if used in complementarity with regular HCC surveillance.
慢性乙型肝炎（CHB）患者的肝细胞癌（HCC）风险预测是一个挑战，尤其是在抗病毒治疗时代。本荟萃分析的目的是全面评估现有 HCC 预测评分在抗病毒治疗中对 HCC 预测的性能。
我们从建库至 2021 年 8 月 24 日，在 PubMed、Web of Science 和 Cochrane Library 中检索了相关的前瞻性研究。计算了风险预测模型的接收者操作特征（ROC）曲线下面积（AUROC）及其相关的 95%置信区间（CI）。
纳入了 9 篇符合条件的文献，共纳入了 21561 例患者（947 例患者发生 HCC，占 4.39%；平均随访时间：5 年）和 14 个预测风险评分。所有纳入评分的 3 年和 5 年 HCC 预测的汇总 AUROC 分别为 0.72（95%CI 0.68-0.76）和 0.80（95%CI 0.76-0.83），相应的敏感性分别为 0.84（95%CI 0.71-0.92）和 0.91（95%CI 0.86-0.95），特异性分别为 0.46（95%CI 0.30-0.63）和 0.48（95%CI 0.37-0.59）。所有 14 个预测模型，整体而言，在不同人群中表现良好，无论是否包含肝硬化状态因素；而那些综合病毒载量的预测模型准确性较低（敏感性 0.78，特异性 0.57）。
在接受抗病毒治疗的 CHB 患者中，我们荟萃分析中纳入的评分已被证明可用于中-长期 HCC 预测。病毒载量似乎没有用处，而肝硬化及其客观替代物仍然是主要成分。如果这些模型与常规 HCC 监测互补使用，预计将转化为临床获益。
