Yin Jianhua, Xu Xiang, Pu Rui, Su Haibin, Wang Junxue, Liu Wenbin, Tong Jingjing, Chen Jing, Chen Xi, Mu Xiuying, Zhang Hongwei, Zhai Xingran, Liu Xiaoyan, Pang Fei, Wang Yu, Wang Huifen, Cao Guangwen, Hu Jinhua
Department of Epidemiology, Second Military Medical University, Shanghai, China.
Senior Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
J Oncol. 2022 Oct 27;2022:5873002. doi: 10.1155/2022/5873002. eCollection 2022.
Activation of chronic hepatitis B virus (HBV) infection is an important cause of acute-on-chronic liver failure (ACLF). However, the effect of HBV-ACLF episode on hepatocellular carcinoma (HCC) occurrence remains largely unknown.
A total of 769 HBV-ACLF patients and 2114 HBV-related chronic liver disease (HBV-CLD) patients diagnosed between August 1998 and December 2011 were enrolled in this prospective cohort study. Of the HBV-CLD patients, 380 received lifetime antiviral treatment with nucleos(t)ide analogues. Propensity score matching was applied to reduce baseline differences between HBV-ACLF and HBV-CLD cohorts.
The survival rate of HBV-ACLF patients was 53.6%, 50.3%, 47.8%, and 46.2% at 90-day, 1-year, 5-year, and 10-year, respectively. The cumulative incidence of HCC was lower in HBV-ACLF cohort with 369 eligible patients survived for >90 days than in HBV-CLD cohort with the 380 patients (5.77/1,000 vs. 9.78/1,000 person-years, = 0.0497). HBV-ACLF episode decreased HCC risk regardless of liver cirrhosis, and in patients without family history of HCC. Multivariate Cox analyses indicated that male, increasing age, liver cirrhosis, and platelet count (≤100 × 10/L) increased, whereas HBV-ACLF episode decreased, HCC risk independently. In the propensity score-matched cohorts, HBV-ACLF episode reduced HCC incidence (10.20/1,000 vs. 4.66/1,000 person-years, = 0.0326). The area under curve of nomogram was 0.812 for 3-year HCC probability.
HBV-ACLF episode decreases HCC occurrence in chronic HBV patients. Older age and liver cirrhosis independently increased HCC occurrence. A nomogram-enrolled episode of ACLF reliably predicts the occurrence of HCC.
慢性乙型肝炎病毒（HBV）感染激活是慢加急性肝衰竭（ACLF）的重要病因。然而，HBV-ACLF发作对肝细胞癌（HCC）发生的影响仍 largely未知。
本前瞻性队列研究纳入了1998年8月至2011年12月期间诊断的769例HBV-ACLF患者和2114例HBV相关慢性肝病（HBV-CLD）患者。在HBV-CLD患者中，380例接受了核苷（酸）类似物的终身抗病毒治疗。应用倾向评分匹配以减少HBV-ACLF和HBV-CLD队列之间的基线差异。
HBV-ACLF患者在90天、1年、5年和10年时的生存率分别为53.6%、50.3%、47.8%和46.2%。在369例存活超过90天的符合条件的患者的HBV-ACLF队列中，HCC的累积发病率低于380例患者的HBV-CLD队列（5.77/1000人年对9.78/1000人年，P = 0.0497）。无论有无肝硬化，以及在无HCC家族史的患者中，HBV-ACLF发作均降低了HCC风险。多因素Cox分析表明，男性、年龄增加、肝硬化和血小板计数（≤100×10⁹/L）增加，而HBV-ACLF发作降低，HCC风险独立存在。在倾向评分匹配队列中，HBV-ACLF发作降低了HCC发病率（10.20/1000人年对4.66/1000人年，P = 0.0326）。列线图预测3年HCC发生概率的曲线下面积为0.812。
HBV-ACLF发作降低了慢性HBV患者HCC的发生。年龄较大和肝硬化独立增加了HCC的发生。纳入ACLF发作情况的列线图可可靠地预测HCC的发生。
