Chronic hepatitis B (CHB) infection constitutes a leading cause of hepatocellular carcinoma (HCC) development. The identification of HCC risk factors and the development of prognostic risk scores are essential for early diagnosis and prognosis. The aim of this observational, retrospective study was to evaluate baseline risk factors associated with HCC in CHB. Six hundred thirty-two consecutive adults with CHB (n= 632) [median age: 46 (IQR: 24)], attending the outpatients’ Hepatology clinics between 01/1993–09/2020 were evaluated. Core promoter mutations and cirrhosis-HCC (GAG-HCC), Chinese University-HCC (CU-HCC), risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B), Fibrosis-4 (FIB-4), and Platelet Age Gender–HBV (PAGE-B) prognostic scores were calculated, and receiver operating curves were used to assess their prognostic performance. HCC was developed in 34 (5.38%) patients. In the multivariable Cox regression analysis, advanced age (HR: 1.086, 95% CI: 1.037–1.137), male sex (HR: 7.696, 95% CI: 1.971–30.046), alcohol abuse (HR: 2.903, 95% CI: 1.222–6.987) and cirrhosis (HR: 21.239, 95% CI: 6.001–75.167) at baseline were independently associated with the development of HCC. GAG-HCC and PAGE-B showed the highest performance with c-statistics of 0.895 (95% CI: 0.829–0.961) and 0.857 (95% CI: 0.791–0.924), respectively. In the subgroup of patients with cirrhosis, the performance of all scores declined. When treated and untreated patients were studied separately, the discriminatory ability of the scores differed. In conclusion, HCC development was independently associated with advanced age, male sex, alcohol abuse, and baseline cirrhosis among a diverse population with CHB. GAG-HCC and PAGE-B showed high discriminatory performance to assess the risk of HCC development in these patients, but these performances declined in the subgroup of patients with cirrhosis. Further research to develop scores more specific to certain CHB subgroups is needed.
慢性乙型肝炎（CHB）感染是肝细胞癌（HCC）发生的主要原因。识别HCC风险因素并建立预后风险评分对早期诊断和预后评估至关重要。本观察性回顾研究旨在评估CHB患者中与HCC相关的基线风险因素。研究纳入了1993年1月至2020年9月期间在肝病门诊连续就诊的632例成年CHB患者[中位年龄：46岁（IQR：24）]，计算了核心启动子突变和肝硬化-HCC（GAG-HCC）、中文大学-HCC（CU-HCC）、慢性乙型肝炎肝细胞癌风险估算（REACH-B）、肝纤维化指数-4（FIB-4）以及血小板年龄性别-HBV（PAGE-B）预后评分，并采用受试者工作特征曲线评估其预后效能。共有34例（5.38%）患者发展为HCC。多变量Cox回归分析显示，高龄（HR：1.086，95% CI：1.037–1.137）、男性（HR：7.696，95% CI：1.971–30.046）、酒精滥用（HR：2.903，95% CI：1.222–6.987）和基线肝硬化（HR：21.239，95% CI：6.001–75.167）与HCC发生独立相关。GAG-HCC和PAGE-B评分表现出最高的预测效能，C统计量分别为0.895（95% CI：0.829–0.961）和0.857（95% CI：0.791–0.924）。在肝硬化亚组患者中，所有评分的预测效能均下降。当分别分析接受治疗与未治疗患者时，评分的区分能力存在差异。综上所述，在多样化的CHB人群中，HCC的发生与高龄、男性、酒精滥用及基线肝硬化独立相关。GAG-HCC和PAGE-B评分在评估这些患者的HCC发生风险方面表现出较高的区分能力，但在肝硬化亚组中其效能下降。未来需要进一步研究开发更针对特定CHB亚组的风险评分系统。
肿瘤(癌症)患者之家