Background

Controlled attenuation parameter (CAP) can evaluate hepatic steatosis in patients with chronic hepatitis B (CHB). However, prognostic implications of CAP value remain unclear. We evaluated the association between CAP and the risk of hepatocellular carcinoma (HCC) in patients with CHB under antiviral therapy and maintained virologic response.

Methods

A total of 1823 CHB patients who were taking nucleos(t)ide analogue and showing suppressed hepatitis B virus replication were analyzed. The primary outcome was incident HCC during follow-up. Patients were grouped into those with and without advanced chronic liver disease (ACLD) (liver stiffness measurement cutoff: 10 kPa), and those with and without hepatic steatosis (CAP cutoff: 222 dB/m).

Results

During 6.4 years of follow-up, 127 patients (7.0%) newly developed HCC. Among patients with ACLD (n = 382), the cumulative HCC incidence rate was lower for those with CAP ≥ 222 (11.0% at 5 years) than those with CAP < 222 (24.0% at 5 years, p = 0.002), and was an independent factor associated with HCC. When CAP value was further stratified, the cumulative HCC incidence rate decreased in dose-dependent manner according to an increase in CAP value (24.0%, 13.9%, 12.8% and 6.0% at 5 years for those with CAP < 222, 222–246, 247–273 and ≥ 274, respectively). Among patients without ACLD (n = 1441), there was no significance difference in HCC risk according to CAP value (HCC incidence rate: 3.3% and 4.0% at 5 years for those with CAP < 222 and CAP ≥ 222, p = 0.20).

Conclusions

Among CHB patients under antiviral therapy showing suppressed HBV replication, low CAP value predicted higher risk for HCC among ACLD patients, indicating that CAP value has a prognostic implication in this population.

中文翻译：

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抗病毒治疗慢性乙型肝炎患者可控衰减参数值与肝细胞癌风险

背景

受控衰减参数（CAP）可以评估慢性乙型肝炎（CHB）患者的肝脏脂肪变性。然而，CAP 值的预后意义仍不清楚。我们评估了 CAP 与接受抗病毒治疗并维持病毒学应答的 CHB 患者发生肝细胞癌 (HCC) 风险之间的关联。

方法

共分析了 1823 名服用核苷（酸）类似物并显示乙型肝炎病毒复制受到抑制的 CHB 患者。主要结果是随访期间发生 HCC。患者分为晚期慢性肝病 (ACLD) 和非晚期慢性肝病 (ACLD)（肝脏硬度测量临界值：10 kPa）和有和无肝脂肪变性（CAP 临界值：222 dB/m）的患者。

结果

在 6.4 年的随访期间，127 名患者 (7.0%) 新发 HCC。在 ACLD 患者 ( n  = 382) 中，CAP ≥ 222 的患者（5 年时为 11.0%）的累积 HCC 发病率低于 CAP < 222 的患者（5 年时为 24.0%，p  = 0.002），并且与 HCC 相关的独立因素。当 CAP 值进一步分层时，累积 HCC 发病率根据 CAP 值的增加呈剂量依赖性降低（CAP < 222、222-246 的患者在 5 年时分别为 24.0%、13.9%、12.8% 和 6.0%） ，分别为 247–273 和 ≥ 274）。在没有 ACLD 的患者中（n  = 1441），根据 CAP 值，HCC 风险没有显着差异（对于 CAP < 222 和 CAP ≥ 222 的患者，HCC 发生率在 5 年时分别为 3.3% 和 4.0%，p  = 0.20）。

结论

在接受抗病毒治疗的 CHB 患者中，HBV 复制受到抑制，低 CAP 值预测 ACLD 患者发生 HCC 的风险较高，表明 CAP 值在该人群中具有预后意义。