基于五年治疗变量的PPACS模型可预测恩替卡韦/替诺福韦治疗患者随后的肝细胞癌发生。
Five-year on-treatment variables-based PPACS model predicts subsequent hepatocellular carcinoma in entecavir/tenofovir-treated patients.
发表日期：2023 Aug 24
作者：
Yeonjung Ha, Jihye Lim, Young Eun Chon, Mi Na Kim, Joo Ho Lee, Kang Mo Kim, Ju Hyun Shim, Danbi Lee, Seong Gyu Hwang, Seungbong Han, Han Chu Lee
来源：
INTERNATIONAL JOURNAL OF CANCER
摘要：
考虑到长期潜在抗病毒治疗可以降低慢性乙型肝炎（CHB）患者患肝细胞癌（HCC）的风险，我们需要建立预测治疗5年后HCC的模型。我们进行了一项多中心回顾性队列研究，构建和验证了一个预测CHB患者经安替沙韦（ETV）或替诺福韦（TFV）治疗5年后HCC的模型。终点是ETV / TFV治疗5年后的HCC。基于初诊（开始ETV/TFV治疗）时的年龄、性别、肝硬化（通过诊断代码评估并由临床发现证实）和抗病毒药物类型收集了信息。实验室值在基线和5年时收集。在训练集中确定了HCC的危险因素，并使用测试集对最终预测模型进行验证。在7542名患者中，345名（4.6％）在ETV / TFV治疗5年后发展为HCC。在基线时，患有肝硬化的患者与未患肝硬化的患者相比，ETV / TFV治疗5年后的HCC风险增加了4倍。此外，在5年时的血小板计数、凝血酶原时间、基线时的年龄和性别与HCC的风险有关，并被纳入预测模型PPACS中。PPACS在8年的ETV / TFV疗法中表现良好，时间相关的曲线下面积为0.80（95％置信区间为0.75-0.85），Brier评分为0.031，在测试集中的整合Brier评分为0.006。总之，PPACS模型可可可靠地评估ETV / TFV治疗5年后的HCC风险（https://ppacs.shinyapps.io/shiny_app_up/）。© 2023 UICC.
Considering the lower risk of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients receiving long-term potent antiviral therapy, models predicting HCC after 5 years of therapy are needed. We conducted a multicenter retrospective cohort study to construct and validate a model predicting HCC after 5 years of entecavir (ETV) or tenofovir (TFV) therapy for CHB. The endpoint was HCC after 5 years of ETV/TFV therapy. Information on age, sex, liver cirrhosis (assessed by diagnosis code and confirmed by clinical findings) and type of antiviral agent was obtained at baseline (initiation of ETV/TFV). Laboratory values were collected at baseline and 5 years. Risk factors for HCC were identified in the training set and the final prediction model was validated using the test set. Among 7542 patients, 345 (4.6%) developed HCC after 5 years of ETV/TFV therapy. HCC risk after 5 years of ETV/TFV therapy was increased by 4-fold in patients with liver cirrhosis than in those without cirrhosis at baseline. Furthermore, Platelet counts and Prothrombin time at 5 years, Age at baseline and Sex were associated with risk of HCC and were incorporated into a prediction model, PPACS. PPACS showed a good performance with a time-dependent area under the curve of 0.80 (95% confidence interval, 0.75-0.85) at 8-year of ETV/TFV therapy, a Brier score of 0.031 and an integrated Brier score of 0.006 in the test set. In conclusion, the PPACS model provides a reliable assessment of HCC risk after 5 years of ETV/TFV therapy (https://ppacs.shinyapps.io/shiny_app_up/).© 2023 UICC.