Wang Hung-Wei, Chen Chi-Yi, Lai Hsueh-Chou, Hu Tsung-Hui, Su Wen-Pang, Lu Sheng-Nan, Hung Chao-Hung, Chuang Po-Heng, Wang Jing-Houng, Chen Chien-Hung, Peng Cheng-Yuan
Centre for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital Taichung, Taiwan.
School of Medicine, China Medical University Taichung, Taiwan.
Am J Cancer Res. 2023 Feb 15;13(2):526-537. eCollection 2023.
The feasibility and performance of predicting hepatocellular carcinoma (HCC) using a combined albumin-bilirubin (ALBI) and fibrosis-4 (FIB-4)-based model remain unclear in patients with compensated cirrhosis and chronic hepatitis B (CHB) receiving long-term nucleos(t)ide analog (NA) therapy. We enrolled 1158 NA-naïve patients with compensated cirrhosis and CHB treated with entecavir or tenofovir disoproxil fumarate. The patients' baseline characteristics, hepatic reserve, and fibrosis indices were analyzed. The combination of ALBI and FIB-4 was used to develop a prediction model of HCC. In this cohort, the cumulative incidence rates of HCC at 3, 5, and 10 years were 8.1%, 13.2%, and 24.1%, respectively. The combination of ALBI and FIB-4, Diabetes mellitus, and Alpha-fetoprotein (AFDA) were independent risk factors for HCC. The combined ALBI and FIB-4-based prediction model (i.e., AFDA) stratified the cumulative risk of HCC into three groups (with risk scores of 0, 1-3, 4-6) among all patients (P < 0.001). AFDA exhibited the highest area under the receiver operating characteristic (0.6812) for predicting HCC, which was higher than those of aMAP (0.6591), mPAGE-B (0.6465), CAMD (0.6379), and THRI (0.6356) and significantly higher than those of PAGE-B (0.6246), AASL-HCC (0.6242), and HCC-RESCUE (0.6242). Patients with a total score of 0 (n = 187, 16.1% of total patients) had the lowest cumulative HCC incidence of 3.4% at 5 years. The combined ALBI and FIB-4-based prediction model can stratify the risk of HCC in patients with compensated cirrhosis and CHB receiving NA therapy.
在接受长期核苷（酸）类似物（NA）治疗的代偿期肝硬化和慢性乙型肝炎（CHB）患者中，使用基于白蛋白-胆红素（ALBI）和纤维化-4（FIB-4）的联合模型预测肝细胞癌（HCC）的可行性和性能仍不明确。我们纳入了1158例初治的代偿期肝硬化和CHB患者，他们接受了恩替卡韦或替诺福韦酯治疗。分析了患者的基线特征、肝脏储备和纤维化指标。使用ALBI和FIB-4的组合建立了HCC预测模型。在该队列中，HCC在3年、5年和10年的累积发病率分别为8.1%、13.2%和24.1%。ALBI和FIB-4的组合、糖尿病和甲胎蛋白（AFDA）是HCC的独立危险因素。基于ALBI和FIB-4的联合预测模型（即AFDA）将所有患者的HCC累积风险分为三组（风险评分为0、1-3、4-6）（P<0.001）。AFDA在预测HCC方面表现出最高的受试者工作特征曲线下面积（0.6812），高于aMAP（0.6591）、mPAGE-B（0.6465）、CAMD（0.6379）和THRI（0.6356），且显著高于PAGE-B（0.6246）、AASL-HCC（0.6242）和HCC-RESCUE（0.6242）。总分0分的患者（n = 187，占总患者的16.1%）在5年时的HCC累积发病率最低，为3.4%。基于ALBI和FIB-4的联合预测模型可以对接受NA治疗的代偿期肝硬化和CHB患者的HCC风险进行分层。
