In:
Alimentary Pharmacology & Therapeutics, Wiley, Vol. 47, No. 8 ( 2018-04), p. 1201-1212
Abstract:
A proportion of chronic hepatitis B ( CHB ) patients are diagnosed with advanced hepatocellular carcinoma ( HCC ) despite regular surveillance. Aims To determine predictors for HCC detection failure in CHB patients who underwent regular surveillance. Methods CHB patients with well‐preserved liver function, who underwent ultrasonography and alpha‐foetoprotein ( AFP ) analysis every 6 months, were enrolled. Cox regression analysis was used to identify predictors for detection failure, defined as HCC initially diagnosed at Barcelona Clinic Liver Cancer ( BCLC ) stage B or C. Results Of the 4590 CHB patients (mean age, 52.1 years; men, 61.6%), 169 patients were diagnosed with HCC (3.68%) and 35 (20.7%) H CC patients were initially diagnosed with HCC BCLC stage B or C. The cumulative incidence of HCC detection failure was 0.2% at year 1 and 1.3% at year 5. Multivariate analyses indicated that cirrhosis (hazard ratio [ HR ], 3.078; 95% CI, 1.389‐6.821; P = 0.006), AFP levels ≥9 ng/mL ( HR , 5.235; 95% CI, 2.307‐11.957; P = 0.010), and diabetes mellitus ( HR , 3.336; 95% CI, 1.341‐8.296; P = 0.010) were independent predictors of HCC detection failure. Another model that incorporated liver stiffness ( LS ) values identified LS values ≥11.7 kPa ( HR , 11.045; 95% CI, 2.066‐59.037; P = 0.005) and AFP levels ≥9 ng/mL ( HR , 4.802; 95% CI, 1.613‐14.297; P = 0.005) as predictors of detection failure. Conclusions In CHB patients undergoing regular surveillance with ultrasonography and alpha‐foetoprotein ( AFP ) analysis every 6 months, the HCC detection failure rate was not high (0.8% per person; 0.1% per test). However, careful attention should be paid in patients with advanced liver fibrosis (clinical cirrhosis or LS value 〉 11.7 kPa), high AFP levels, or diabetes mellitus, who are prone to surveillance failure.
Type of Medium:
Online Resource
ISSN:
0269-2813
,
1365-2036
DOI:
10.1111/apt.2018.47.issue-8
Language:
English
Publisher:
Wiley
Publication Date:
2018
detail.hit.zdb_id:
2003094-0
SSG:
15,3
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