Background: Dynamic changes in fibrosis markers occur under long-term antiviral treatment (AVT) for chronic hepatitis B. We evaluated prognostic values of on-treatment liver stiffness (LS) compared to ultrasonography findings and determined its optimal cutoff.
Methods: The cumulative probability of hepatocellular carcinoma (HCC) was assessed among 880 patients receiving entecavir or tenofovir for ≥ 2 years. LS was measured using transient elastography.
Results: After ≥ 2 years’ AVT, the proportion of patients with cirrhosis on ultrasonography decreased from 54.7% to 44.9% and the mean LS decreased from 13.6 to 8.2 kPa (both p< 0.001). However, unlike cirrhosis on ultrasonography before AVT (p< 0.001), that after ≥ 2 years’ AVT did not discriminate HCC risk (p=0.792). Using the Contal and O’Quigley’s method, pre-AVT and on-treatment LS of 12.0 and 6.4 kPa, respectively, were chosen as optimal cutoffs to successfully discriminate HCC risk (both p< 0.001). However, through stratification using both pre-AVT and on-treatment LS, the prognosis was finally determined according to on-treatment LS of 6.4 kPa, regardless of pre-AVT LS of 12.0 kPa. Using on-treatment LS of 12 kPa suggested by Caucasians with CHB receiving long-term AVT, patients with higher LS were more likely to develop HCC than those with lower LS (p=0.017); however, there was no significant difference between those with on-treatment LS of 6.4– 11.9 and ≥ 12.0 kPa (p=0.920).
Conclusion: For HCC risk stratification in patients receiving long-term AVT, on-treatment LS cutoff should be lowered to 6.4 kPa, which is more predictive than 12 kPa or cirrhosis on ultrasonography. Further studies are required for validation.



中文翻译：

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治疗性肝僵直对慢性乙型肝炎患者肝细胞癌发展的预后作用

背景：在长期抗病毒治疗（AVT）下，慢性乙型肝炎的纤维化标记物发生动态变化。我们与超声检查结果相比较，评估了治疗中肝脏僵硬（LS）的预后价值，并确定了其最佳临界值。
方法：在880名接受恩替卡韦或替诺福韦治疗≥2年的患者中评估了肝细胞癌（HCC）的累积概率。LS使用瞬时弹性成像法测量。
结果：AVT≥2年后，超声检查中肝硬化患者的比例从54.7％降低到44.9％，平均LS从13.6降低到8.2 kPa（均p <0.001）。但是，与AVT之前的超声检查中的肝硬化不同（p <0.001），≥2年的AVT后不能鉴别出HCC风险（p = 0.792）。使用Contal法和O'Quigley法，分别选择AVT前和治疗中LS为12.0和6.4 kPa作为最佳临界值，以成功地区分HCC风险（均p <0.001）。然而，通过使用AVT前LS和治疗前LS进行分层，最终根据6.4 kPa的治疗中LS来确定预后，而与AVT LS之前的12.0 kPa无关。使用接受长期AVT的高加索人高加索人建议的治疗中LS为12 kPa，LS较高的患者比LS较低的患者更容易发生HCC（p = 0.017）；但是，治疗中LS为6.4–11.9且≥12.0 kPa的患者之间无显着差异（p = 0.920）。
结论：对于接受长期AVT的患者进行HCC危险分层，应将治疗中的LS截止值降低至6.4 kPa，这比超声检查中12 kPa或肝硬化的预测性更高。验证需要进一步的研究。