【原创】J Hepatol：慢性乙型肝炎患者HBsAg血清清除后肝细胞癌的发生率：需要监测

背景和目的

对于表面抗原血清清除的慢性乙型肝炎患者，是否该继续监测肝细胞癌的发生，这方面的研究很少。

方法

本研究是回顾性分析了1997-2012年韩国三级医院的达到了表面抗原血清清除的829例患者（平均年龄52.3岁，575例男性，98例合并有肝硬化）。我们评估了肝癌的发生率并验证了基于表面抗原血清清除时间点的CU-HCC肝癌风险评分。

结果

在3464随访人年中，19例患者发展为肝癌（年发生率为0.55%），在表面抗原血清清除的时间点，肝硬化、男性、年龄大于50，是肝细胞癌发生的独立危险因素。预估有肝硬化和没有肝硬化的乙肝患者每年肝癌发生率分别为2.85%和0.29%，在没有肝硬化的患者中，男性患者发生肝癌的几率大于女性，所有肝癌的发生在50岁以后。时间依赖的受试者特征曲线下面积的CU-HCC肝癌风险评分，对肝癌的5年及10年预测分别为0.85和0.74。

结论

即使获得了表面抗原的血清清除，肝硬化患者及年龄大于50的男性非肝硬化患者，特别是C型HBV感染的患者，都需要监测肝癌发生的可能。表面抗原清除发生的时间在50岁以后，也是肝细胞发生的独立预测因素。

INCIDENCE OF HEPATOCELLULAR CARCINOMA AFTER HBSAG SEROCLEARANCE IN CHRONIC HEPATITIS B PATIENTS: A NEED FOR SURVEILLANCE.

BACKGROUND & AIMS:

Little is known about whether surveillance for hepatocellular carcinoma (HCC) is worthwhile in chronic hepatitis B virus (HBV)-infected patients who have achieved HBsAg seroclearance.

METHODS:

A retrospective analysis of 829 patients (mean age: 52.3years; 575 males; 98 with cirrhosis) achieving HBsAg seroclearance was performed at a tertiary hospital in Korea between 1997 and 2012. We evaluated incidence rates of HCC, and validated CU-HCC score based on data at the time of HBsAg seroclearance.

RESULTS:

During a follow-up of 3464 patient-years, 19 patients developed HCC (annual rate: 0.55%). Liver cirrhosis (hazard ratio [HR]: 10.80; 95% confidence interval [CI]: 4.25-27.43), male gender (HR: 8.96; 95% CI: 1.17-68.80), and age ⩾50years at the time of HBsAg seroclearance (HR: 12.14; 95% CI: 1.61-91.68) were independently associated with HCC. The estimated annual incidence of HCC was 2.85% and 0.29% in patients with and without cirrhosis, respectively. Among the non-cirrhotic patients, the annual rate of HCC was higher in the male patients than in the females (0.40% vs. 0%, respectively), and all the HCCs developed after age 50. The time-dependent area under the receiver operating characteristic curves for the CU-HCC score for 5year and 10year HCC prediction were 0.85 and 0.74, respectively.

CONCLUSIONS:

HCC surveillance should be considered for cirrhotic patients and non-cirrhotic male patients over age 50, even after HBsAg seroclearance, especially those infected with HBV genotype C. HBsAg seroclearance at age ⩾50years was also an independent predictor for HCC.