School of Medicine, China Medical University, Taichung, Taiwan; Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan.
J Formos Med Assoc. 2024 Dec;123(12):1279-1286. doi: 10.1016/j.jfma.2024.02.016. Epub 2024 Mar 6.
Purpose: This study aimed to directly compare the utility of liver stiffness (LS) and spleen stiffness (SS) at sustained virologic response (SVR) for predicting hepatocellular carcinoma (HCC) and non-HCC events in patients with chronic hepatitis C (CHC) after direct-acting antiviral therapy.
This retrospective study included 695 CHC patients who achieved SVR and underwent LS and SS measurements. LS and SS were measured using point shear wave elastography and compared head-to-head.
During a median follow-up of 29.5 months, 49 (7.1%) patients developed liver-related events (LREs), including 28 HCC and 22 non-HCC events after SVR. Multivariable Cox regression analysis revealed that age, albumin level, and LS (≥ versus <1.46 m/s) at SVR (adjusted hazard ratio [aHR]: 5.390; 95% confidence interval [CI]: 2.349-12.364; p < 0.001), but not SS at SVR, significantly predicted the overall risk of post-SVR LREs (n = 49). Furthermore, age and LS (≥ versus <1.46 m/s) at SVR (aHR: 6.759; 95% CI: 2.317-19.723; p < 0.001), but not SS at SVR, independently predicted the risk of post-SVR incident HCC. In contrast, SS (≥ versus <2.87 m/s) at SVR (aHR: 11.212; 95% CI: 1.564-20.132; p = 0.021) and albumin level, but not LS at SVR, significantly predicted the risk of post-SVR non-HCC events.
Post-SVR LS better predicts HCC risk. Post-SVR SS helps predict non-HCC risk after antiviral therapy for CHC. LS and SS at SVR provide complementary prognostic information regarding risks of HCC and non-HCC events in the post-SVR setting. Further validation is warranted in larger cohorts.
目的：本研究旨在直接比较肝硬度（LS）和脾脏硬度（SS）在持续病毒学应答（SVR）时对预测慢性丙型肝炎（CHC）患者直接抗病毒治疗后肝细胞癌（HCC）和非 HCC 事件的作用。
本回顾性研究纳入了 695 例达到 SVR 并接受 LS 和 SS 测量的 CHC 患者。使用点剪切波弹性成像测量 LS 和 SS，并进行直接比较。
在中位随访 29.5 个月期间，49 例（7.1%）患者发生了肝相关事件（LREs），包括 SVR 后 28 例 HCC 和 22 例非 HCC 事件。多变量 Cox 回归分析显示，年龄、白蛋白水平和 SVR 时的 LS（≥1.46 m/s 与 <1.46 m/s）（校正后的危险比[aHR]：5.390；95%置信区间[CI]：2.349-12.364；p<0.001），而 SVR 时的 SS 并不显著预测 SVR 后 LREs 的总体风险（n=49）。此外，年龄和 SVR 时的 LS（≥1.46 m/s 与 <1.46 m/s）（aHR：6.759；95%CI：2.317-19.723；p<0.001），但 SVR 时的 SS 并不独立预测 SVR 后 HCC 的发生风险。相比之下，SVR 时的 SS（≥2.87 m/s 与 <2.87 m/s）（aHR：11.212；95%CI：1.564-20.132；p=0.021）和白蛋白水平，但 SVR 时的 LS 并不显著预测 SVR 后非 HCC 事件的风险。
SVR 后的 LS 更好地预测 HCC 风险。SVR 后的 SS 有助于预测 CHC 抗病毒治疗后的非 HCC 风险。SVR 时的 LS 和 SS 提供了关于 SVR 后 HCC 和非 HCC 事件风险的互补预后信息。需要在更大的队列中进一步验证。
