Clinical Epidemiology & EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
National Clinical Research Center for Digestive Diseases, Beijing, China.
Hepatol Int. 2023 Dec;17(6):1350-1358. doi: 10.1007/s12072-023-10567-0. Epub 2023 Aug 19.
Long-term treatment with nucleoside analog (NA) reduces the risks for decompensation and hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients with compensated cirrhosis (CC). However, whether antiviral therapy has differential efficacy on the risks for decompensation and HCC is insufficiently elucidated. Therefore, we investigated the disease state transition, focusing on decompensation event-specific HCC risk in NA-treated CHB patients with CC.
We prospectively followed up on 1163 NA-treated CHB patients with CC every six months for up to seven years. The cumulative incidence and risk of HCC were analyzed by the Kaplan-Meier method and competing risk model. The multistate model was used to estimate the transition probabilities to HCC from different disease states.
HCC predominated the first liver-related events, with a 5-year cumulative incidence of 9.0%, followed by decompensation (8.3%, including 7.9% nonbleeding decompensation and 2.4% variceal bleeding) and 0.2% death. The decompensation stage had a significantly higher 5-year cumulative HCC incidence than the CC stage (27.6% vs. 9.1%; HR = 2.42, 95% CI: 1.24, 4.71). Furthermore, nonbleeding decompensation events had a higher 5-year transition probability to HCC than bleeding (27.6% vs. 15.8%; HR = 2.69, 95% CI: 1.41, 4.17). Viral suppression modified the on-treatment transition risk to HCC (1-year: HR = 0.45, 95% CI: 0.28, 0.73; 3-year: HR = 0.23, 95% CI: 0.14, 0.38). An online calculator was developed to facilitate HCC risk stratification.
In NA-treated CHB patients with compensated cirrhosis, the risk was higher for HCC than for decompensation; more importantly, different decompensation events conferred distinct HCC risks.
核苷（酸）类似物（NA）长期治疗可降低代偿性肝硬化（CC）慢性乙型肝炎（CHB）患者失代偿和肝细胞癌（HCC）的风险。然而，抗病毒治疗对失代偿和 HCC 风险的疗效是否存在差异尚不清楚。因此，我们研究了疾病状态的转变，重点关注 NA 治疗的 CC 型 CHB 患者中与失代偿事件相关的 HCC 风险。
我们前瞻性地每 6 个月随访 1163 例 NA 治疗的 CC 型 CHB 患者，随访时间长达 7 年。Kaplan-Meier 法和竞争风险模型分析 HCC 的累积发生率和风险。多状态模型用于估计不同疾病状态向 HCC 的转移概率。
HCC 是首次发生的肝脏相关事件，5 年累积发生率为 9.0%，其次是失代偿（8.3%，包括 7.9%非出血性失代偿和 2.4%静脉曲张出血）和 0.2%死亡。失代偿期的 5 年 HCC 累积发生率明显高于 CC 期（27.6%比 9.1%；HR=2.42，95%CI：1.24，4.71）。此外，非出血性失代偿事件向 HCC 的 5 年转移概率高于出血性失代偿事件（27.6%比 15.8%；HR=2.69，95%CI：1.41，4.17）。病毒抑制改变了治疗期间向 HCC 的转变风险（1 年：HR=0.45，95%CI：0.28，0.73；3 年：HR=0.23，95%CI：0.14，0.38）。开发了一个在线计算器以方便 HCC 风险分层。
在 NA 治疗的 CC 型 CHB 患者中，HCC 的风险高于失代偿；更重要的是，不同的失代偿事件具有不同的 HCC 风险。
