Liu Yuh-Ying, Lin Chih-Lang, Weng Cheng-Hao, Chang Pei-Hung, Chien Cheng-Hung, Huang Kuang-Chen, Hua Man-Chin, Hu Ching-Chih
Liver Research Unit, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Keelung 20401, Taiwan.
College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
Diagnostics (Basel). 2022 Aug 28;12(9):2085. doi: 10.3390/diagnostics12092085.
Background: Nucleos(t)ide analogues (NUCs) were proved to reduce hepatocellular carcinoma (HCC) development in chronic hepatitis B (CHB) patients, but data were limited on their efficacy in cirrhotic CHB patients. Methods: A total of 447 cirrhotic CHB patients treated with tenofovir/entecavir were retrospectively analyzed and divided into HCC (n = 48) and non-HCC (n = 399) groups. The median follow-up period was 62.1 months. Results: A total of 48 patients (10.7%) developed HCC during surveillance. The annual incidence rate of HCC was 2.04 per 100 person-years. The cumulative incidence of HCC was 0.9%, 9.8%, and 22.1% at 1, 5, and 10 years, respectively. Significant predictors for HCC identified using a multiple Cox regression analysis were age ≥50 years (hazard ratio (HR): 2.34) and α-fetoprotein (AFP) ≥8 ng/mL (HR: 2.05). The incidence rate of HCC was 8.67-fold higher in patients with age ≥50 years and AFP ≥8 ng/mL (3.14 per 100 person-years) than those with age <50 years and AFP <8 ng/mL (0.36 per 100 person-years). Conclusions: Cirrhotic CHB patients with age <50 years and AFP <8 ng/mL had the lowest annual incidence of HCC. However, those with age ≥50 years or/and AFP ≥8 ng/mL had a significantly higher risk for HCC development and warrant a careful surveillance schedule.
核苷（酸）类似物（NUCs）已被证明可降低慢性乙型肝炎（CHB）患者肝细胞癌（HCC）的发生风险，但关于其在CHB肝硬化患者中的疗效数据有限。方法：对447例接受替诺福韦/恩替卡韦治疗的CHB肝硬化患者进行回顾性分析，并分为HCC组（n = 48）和非HCC组（n = 399）。中位随访期为62.1个月。结果：共有48例患者（10.7%）在监测期间发生HCC。HCC的年发病率为每100人年2.04例。HCC的累积发病率在1年、5年和10年时分别为0.9%、9.8%和22.1%。采用多因素Cox回归分析确定的HCC显著预测因素为年龄≥50岁（风险比（HR）：2.34）和甲胎蛋白（AFP）≥8 ng/mL（HR：2.05）。年龄≥50岁且AFP≥8 ng/mL的患者（每100人年3.14例）发生HCC的发病率比年龄<50岁且AFP<8 ng/mL的患者（每100人年0.36例）高8.67倍。结论：年龄<50岁且AFP<8 ng/mL的CHB肝硬化患者HCC年发病率最低。然而，年龄≥50岁或/和AFP≥8 ng/mL的患者发生HCC的风险显著更高，需要制定仔细的监测计划。
