Center for Global Health, Istituto Superiore Di Sanità (ISS), Rome, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
Center for Global Health, Istituto Superiore Di Sanità (ISS), Rome, Italy.
Dig Liver Dis. 2023 Jul;55(7):907-917. doi: 10.1016/j.dld.2023.01.153. Epub 2023 Feb 10.
Severe liver disease markers assessed before HCV eradication are acknowledged to usually improve after the SVR. We prospectively evaluated, in the PITER cohort, the long-term HCC risk profile based on predictors monitored after HCV eradication by direct-acting antivirals in patients with cirrhosis.
HCC occurrence was evaluated by Kaplan-Meier analysis. Cox regression analysis identified the post-treatment variables associated with de-novo HCC; their predictive power was presented in a nomogram.
After the end of therapy (median follow-up:28.47 months), among 2064 SVR patients, 119 (5.8%) developed de-novo HCC. The HCC incidence was 1.90%, 4.21%, 6.47% at 12-, 24- and 36-months from end-of-therapy, respectively (incidence rate 2.45/100 person-years). Age, genotype 3, diabetes, platelets (PLT)≤120,000/µl and albumin ≤3.5g/dl levels were identified as pre-treatment HCC independent predictors. Adjusting for age, the post-treatment PLT≤120,000/µl (AdjHR 1.92; 95%CI:1.06-3.45) and albumin≤3.5g/dl (AdjHR 4.38; 95%CI 2.48-7.75) values were independently associated with HCC occurrence. Two different risk profiles were identified by combining long-term post-therapy evaluation of PLT ≤ vs. >120,000/µl and albumin ≤ vs. >3.5g/dl showing a significant different HCC incidence rate of 1.35 vs. 3.77/100 p-y, respectively.
The nomogram score based on age, PLT and albumin levels after SVR showed an accurate prediction capability and may support the customizing management for early HCC detection.
在 HCV 清除之前评估的严重肝脏疾病标志物通常在 SVR 后会改善。我们前瞻性地评估了 PITER 队列，在肝硬化患者中使用直接作用抗病毒药物清除 HCV 后，根据预测因子监测的长期 HCC 风险特征。
通过 Kaplan-Meier 分析评估 HCC 的发生。Cox 回归分析确定了与治疗后新发生 HCC 相关的变量；在列线图中呈现了它们的预测能力。
在治疗结束后（中位随访：28.47 个月），在 2064 例 SVR 患者中，有 119 例（5.8%）发生了新发生的 HCC。HCC 的发生率分别为治疗结束后 12、24 和 36 个月时的 1.90%、4.21%和 6.47%（发生率为 2.45/100 人年）。年龄、基因型 3、糖尿病、血小板（PLT）≤120,000/µl 和白蛋白≤3.5g/dl 水平被确定为治疗前 HCC 的独立预测因素。在调整年龄后，PLT≤120,000/µl（调整后 HR 1.92；95%CI：1.06-3.45）和白蛋白≤3.5g/dl（调整后 HR 4.38；95%CI 2.48-7.75）值与 HCC 的发生独立相关。通过结合治疗后长期评估 PLT≤vs.>120,000/µl 和白蛋白≤vs.>3.5g/dl，识别出两种不同的风险谱，显示出显著不同的 HCC 发生率，分别为 1.35 和 3.77/100 p-y。
基于 SVR 后年龄、PLT 和白蛋白水平的列线图评分显示出准确的预测能力，可能支持定制管理以早期检测 HCC。
