國家衛生研究院 NHRI:Item 3990099045/11088
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    题名: Development of a scoring system to Predict Hepatocellular Carcinoma in Asians on Antivirals for Chronic Hepatitis B
    作者: Hsu, YC;Yip, CF;Ho, HJ;Wong, WS;Huang, YT;El-Serag, HB;Lee, TY;Wu, MS;Lin, JT;Wong, GLH;Wu, CY
    贡献者: Institute of Population Health Sciences
    摘要: BACKGROUND & AIMS: The risk of hepatocellular carcinoma (HCC) during antiviral therapy in patients with chronic hepatitis B (CHB) is inadequately predicted by the scores built from untreated patients. We aimed to develop and validate a risk score to predict HCC in CHB patients on entecavir or tenofovir treatment. METHODS: This study analyzed population-wide data from the healthcare databases in Taiwan and Hong Kong to identify CHB patients continuously receiving entecavir or tenofovir. The development cohort included 23,851 patients from Taiwan; 596 (2.50%) of them developed HCC with a 3-year cumulative incidence of 3.56% (95% CI, 3.26-3.86%). The multivariable Cox proportional hazard model found cirrhosis, age (cirrhosis and age interacted with each other), male sex, and diabetes mellitus were the risk determinants. These variables were weighted to develop the CAMD score ranging from 0 to 19 points. The score was externally validated in 19,321 patients from Hong Kong. RESULTS: The c indices for HCC in the development cohort were 0.83 (95% CI, 0.81-0.84), 0.82 (95% CI, 0.81-0.84), and 0.82 (95% CI, 0.80-0.83) at the first, second, and third year of therapy, respectively. In the validation cohort, the c indices were 0.74 (95% CI, 0.71-0.77), 0.75 (95% CI, 0.73-0.78), and 0.75 (95% CI, 0.72-0.77) during the first 3 years, and 0.76 (95% CI, 0.74-0.78) and 0.76 (95% CI, 0.74-0.77) in the extrapolated fourth and fifth years. The predicted and the observed probabilities of HCC were calibrated in both cohorts. A score <8 and >13 points identified patients at distinctly low and high risks. CONCLUSIONS: The easily calculable CAMD score can predict HCC and may inform surveillance policy in CHB patients during oral antiviral therapy. LAY SUMMARY: This study analyzes population-wide data from the healthcare systems in Taiwan and Hong Kong to develop and validate a risk score that predicts hepatocellular carcinoma (HCC) during oral antiviral therapy in patients with chronic hepatitis B (CHB). The easily calculable CAMD score requires only simple information (i.e., cirrhosis, age, male sex, and diabetes mellitus) at the baseline of treatment initiation. With a scoring range from 0 to 19 points, the CAMD score discriminates the risk of HCC with a concordance rate around 75 approximately 80% during the first 3 years on therapy. The risk prediction can be extrapolated to 5 years on treatment with similar accuracy. Patients with a score <8 and >13 points were exposed to distinctly lower and higher risks, respectively.
    日期: 2018-08
    關聯: Journal of Hepatology. 2018 Aug;69(2):278-285.
    Link to: http://dx.doi.org/10.1016/j.jhep.2018.02.032
    JIF/Ranking 2023: http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0168-8278&DestApp=IC2JCR
    Cited Times(WOS): https://www.webofscience.com/wos/woscc/full-record/WOS:000438753600005
    Cited Times(Scopus): https://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85045570399
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