Risk factors for hepatocellular carcinoma in patients with chronic hepatitis B

• Main Author: LIU Long
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2021-07-01
• Series: Linchuang Gandanbing Zazhi
• Online Access: http://www.lcgdbzz.org/cn/article/doi/10.3969/j.issn.1001-5256.2021.07.022

ObjectiveTo investigate the risk factors for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). MethodsA total of 1239 patients who were diagnosed with CHB in Beijing Ditan Hospital from January 2013 to June 2015 and were followed up for more than 3 years were enrolled, among whom 1108 had no liver cirrhosis and 131 had liver cirrhosis. General information and laboratory markers were collected. The chi-square test was used for comparison of categorical data between groups, and the t-test or the Mann-Whitney U test was used for comparison of continuous data between groups. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test for comparison of categorical data between two groups. A multivariate Cox regression analysis was used to identify the independent risk factors for HCC. The area under the ROC curve (AUC) was used to compare the ability of fibrosis-4 (FIB-4), modified FIB-4 (mFIB-4), and aspartate aminotransferase-to-platelet ratio index (APRI) scores to predict the development of HCC, and the DeLong test was used for comparison of AUC. Goodness of fit was used to evaluate the calibration ability of mFIB-4 score. The Kaplan-Meier method was used to analyze the development of HCC, and the log-rank test was used for comparison. Results The median follow-up time was 4.6 years, and of all patients, 37 (3.0%) developed HCC. The multivariate Cox regression analysis showed that age (hazard ratio ［HR］=1.046, 95% confidence interval ［CI］: 1.018-1.074, P=0.001), alanine aminotransferase (ALT) (HR=0.995, 95%CI: 0.992-0.999, P=0.008), aspartate aminotransferase (AST) (HR=0.994, 95%CI: 0.990-0.998, P=0.020), and platelet count (PLT) (HR=0.988, 95%CI: 0.981-0.994, P=0.001) were independent risk factors for HCC in CHB patients. The mFIB-4, FIB-4, and APRI scores had an AUC of 0.771, 0.658, and 0.676, respectively, and mFIB-4 score had a significantly higher AUC than FIB-4 score (Z=5.629, P＜0.000 1) and APRI score (Z=4.243, P＜0.000 1). Compared with the patients with mFIB-4＜2.68, the patients with mFIB-4 ≥2.68 had a significantly higher risk of HCC (Z=37.840, P＜0.000 1). ConclusionAge, ALT, AST, and PLT are independent risk factors for HCC in CHB patients. Compared with FIB-4 and APRI scores, mFIB-4 score has a higher value in predicting HCC in CHB patients. The patients with mFIB-4 ≥2.68 are the high-risk population of HCC.