Yang Zeyuan, Cheung Ramsey C, Chitnis Amit S, Zhang Wei, Gish Robert G, Wong Robert J
Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA.
JHEP Rep. 2023 Jul 19;5(10):100852. doi: 10.1016/j.jhepr.2023.100852. eCollection 2023 Oct.
BACKGROUND & AIMS: The vast majority of studies evaluating differences in on-treatment risks of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) have been conducted in Asia. Data on the course of CHB on antiviral therapy among predominantly non-Asian populations is less well described. We aimed to evaluate overall risks of cirrhosis and HCC and the influence of baseline factors on this risk among a predominantly non-Asian cohort of patients with CHB in the US.
Using longitudinal data from the national Veterans Affairs database, we evaluated the incidence of cirrhosis or HCC among adults with non-cirrhotic CHB on continuous antiviral therapy. Cumulative incidence functions and adjusted Cox proportional hazards models employed competing risks methods and evaluated overall risk and predictors of developing cirrhosis or HCC while on treatment.
Among 2,496 patients with non-cirrhotic CHB (39.1% African American, 38.4% non-Hispanic White, 18.8% Asian, mean age 58.0 ± 13.4 years), the overall incidences of cirrhosis and HCC were 3.99 per 100 person-years (95% CI 3.66-4.35) and 0.43 per 100 person-years (95% CI 0.33-0.54), respectively. The highest incidences of cirrhosis and HCC were observed in non-Hispanic White patients (5.74 and 0.52 per 100 person-years, respectively), which were significantly higher than in Asian patients (1.93 and 0.17 per 100 person-years, respectively, <0.0001). On multivariate regression, only baseline FIB-4 score was consistently associated with long-term risk of cirrhosis or HCC.
Using a longitudinal cohort of predominantly non-Asian Veterans with non-cirrhotic CHB on antiviral therapy (an understudied population), we provide important epidemiological data to describe long-term risks of cirrhosis and HCC.
In one of the largest studies to date of a predominantly non-Asian cohort of patients with non-cirrhotic chronic hepatitis B, we provide important epidemiological data describing the long-term risks of cirrhosis and hepatocellular carcinoma among patients on antiviral therapies. Among this understudied population, the overall incidence of cirrhosis was 3.99 per 100-person-years (95% CI 3.66-4.35) and of HCC was 0.43 per 100-person-years (95% CI 0.33-0.54). These data also emphasize the importance of continued monitoring and HCC surveillance among CHB patients who are maintained on antiviral therapies.
绝大多数评估慢性乙型肝炎（CHB）患者接受治疗时肝细胞癌（HCC）风险差异的研究是在亚洲进行的。在主要为非亚洲人群中，关于CHB抗病毒治疗过程的数据描述较少。我们旨在评估美国一个主要为非亚洲CHB患者队列中肝硬化和HCC的总体风险，以及基线因素对该风险的影响。
利用国家退伍军人事务数据库的纵向数据，我们评估了接受持续抗病毒治疗的非肝硬化CHB成年患者中肝硬化或HCC的发生率。累积发病率函数和校正后的Cox比例风险模型采用竞争风险方法，评估了治疗期间发生肝硬化或HCC的总体风险及预测因素。
在2496例非肝硬化CHB患者中（39.1%为非裔美国人，38.4%为非西班牙裔白人，18.8%为亚洲人，平均年龄58.0±13.4岁），肝硬化和HCC的总体发病率分别为每100人年3.99例（95%CI 3.66 - 4.35）和每100人年0.43例（95%CI 0.33 - 0.54）。非西班牙裔白人患者中肝硬化和HCC的发病率最高（分别为每100人年5.74例和0.52例），显著高于亚洲患者（分别为每100人年1.93例和0.17例，<0.0001）。多因素回归分析显示，只有基线FIB - 4评分始终与肝硬化或HCC的长期风险相关。
通过对一组主要为非亚洲的接受抗病毒治疗的非肝硬化CHB退伍军人进行纵向队列研究（这是一个研究较少的人群），我们提供了重要的流行病学数据来描述肝硬化和HCC的长期风险。
在迄今为止规模最大的一项主要针对非亚洲非肝硬化慢性乙型肝炎患者队列的研究中，我们提供了重要的流行病学数据，描述了接受抗病毒治疗患者中肝硬化和肝细胞癌的长期风险。在这个研究较少的人群中，肝硬化的总体发病率为每100人年3.99例（95%CI 3.66 - 4.35），HCC为每100人年0.43例（95%CI 0.33 - 0.54）。这些数据还强调了对接受抗病毒治疗的CHB患者持续监测和HCC筛查的重要性。
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