Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong.
Clin Gastroenterol Hepatol. 2023 Oct;21(11):2864-2875.e16. doi: 10.1016/j.cgh.2023.02.004. Epub 2023 Feb 22.
BACKGROUND & AIMS: We examined whether changing clinical characteristics and presence of diabetes mellitus (DM) impact the performance of hepatocellular carcinoma (HCC) risk scores.
Adult patients with chronic hepatitis B (CHB) on ≥6 months of entecavir/tenofovir treatment between January 2005 and March 2020 were identified using a territory-wide electronic database in Hong Kong. DM was defined by antidiabetic agents, hemoglobin A1c ≥6.5%, fasting glucose ≥7 mmol/L, and/or diagnosis codes. PAGE-B, modified PAGE-B (mPAGE-B), and aMAP scores were assessed by area under the time-dependent receiver operating characteristic curves (AUROCs) and compared with CAMD and REAL-B scores with DM as a component.
Of 48,706 patients, 2792, 11,563, 15,471, and 18,880 started entecavir/tenofovir treatment between 2005-2008, 2009-2012, 2013-2016, and 2017-2020, respectively; DM prevalence rose from 15.5% in 2005-2008 to 24.3% in 2017-2020. AUROCs were comparable across the 4 periods in the 5 HCC risk scores (AUROCs ranged between 0.75 and 0.81). At a median follow-up of 4.4 years, 1512 non-diabetic (4.0%) and 645 (6.2%) diabetic patients developed HCC. AUROCs of all 5 scores were lower in diabetic patients than in non-diabetic patients (AUROCs ranged between 0.67-0.71 vs 0.78-0.82; all P < .001). REAL-B score achieved an AUROC of 0.71 in diabetic and 0.82 in non-diabetic patients. Both diabetic and non-diabetic patients in the low-risk group by REAL-B score had a low HCC incidence below the threshold of cost-effective HCC surveillance, ie, 0.2% annually.
REAL-B score is accurate and preferred in entecavir/tenofovir-treated CHB patients because of the increasing prevalence of DM.
本研究旨在探讨临床特征和糖尿病（DM）的变化是否会影响肝细胞癌（HCC）风险评分的性能。
本研究使用香港全港性电子数据库，对 2005 年 1 月至 2020 年 3 月期间接受恩替卡韦/替诺福韦治疗≥6 个月的慢性乙型肝炎（CHB）成年患者进行了分析。DM 的定义为使用降糖药物、糖化血红蛋白≥6.5%、空腹血糖≥7mmol/L 以及（或）诊断代码。采用时间依赖性受试者工作特征曲线下面积（AUROC）评估 PAGE-B、改良 PAGE-B（mPAGE-B）和 aMAP 评分，并将其与包含 DM 的 CAMD 和 REAL-B 评分进行比较。
在 48706 例患者中，分别有 2792、11563、15471 和 18880 例患者于 2005-2008、2009-2012、2013-2016 和 2017-2020 年开始接受恩替卡韦/替诺福韦治疗；DM 的患病率从 2005-2008 年的 15.5%上升到 2017-2020 年的 24.3%。在 5 种 HCC 风险评分中，4 个时期的 AUROC 均相当（AUROC 范围为 0.75 至 0.81）。中位随访 4.4 年后，1512 例非糖尿病（4.0%）和 645 例糖尿病（6.2%）患者发生 HCC。与非糖尿病患者相比，所有 5 种评分的糖尿病患者的 AUROC 均较低（AUROC 范围为 0.67-0.71 与 0.78-0.82；均<0.001）。REAL-B 评分在糖尿病患者中的 AUROC 为 0.71，而非糖尿病患者中的 AUROC 为 0.82。REAL-B 评分低风险组的糖尿病和非糖尿病患者 HCC 发生率均低于成本效益 HCC 监测的阈值（即每年 0.2%）。
由于 DM 的患病率不断上升，REAL-B 评分在接受恩替卡韦/替诺福韦治疗的 CHB 患者中是准确且优选的。
