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Published on: September 30, 2021
How to predict HCC development in patients with chronic B viral liver disease?
Kwang-Hyub Han1, Sang Hoon Ahn
1Department of Internal Medicine and Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea. gihankhys@yumc.yonsei.ac.kr
Insights
Screening for hepatocellular carcinoma (HCC) using an individual prediction model (IPM) is beneficial for high-risk patients with chronic hepatitis B virus (HBV) infection. This tailored approach aids early detection and improves survival in endemic areas.
Area of Science:
- Hepatology
- Oncology
- Public Health
Background:
- Hepatocellular carcinoma (HCC) is a significant malignancy, particularly in Asia.
- Chronic hepatitis B virus (HBV) infection is a primary risk factor for HCC development, often progressing through cirrhosis.
- Geographical variations in HCC incidence necessitate region-specific surveillance strategies.
Purpose of the Study:
- To develop and validate an individual prediction model (IPM) for HCC risk assessment.
- To establish a tailored screening program for early HCC detection in high-risk populations.
- To evaluate the effectiveness of the IPM-based screening program on patient survival.
Main Methods:
- Analysis of risk factors in a cohort of 4,339 Korean patients with chronic HBV infection.
- Development of an IPM based on the calculated relative weights of identified risk factors.
- Prospective validation of a self-developed HCC screening program utilizing the IPM, including 6-month ultrasound (US) intervals.
Main Results:
- The IPM effectively identified individuals at higher risk for HCC.
- Six-month US screening demonstrated efficacy in early HCC detection, particularly within the high-risk cohort.
- The tailored screening program using IPM was prospectively confirmed to be useful and associated with prolonged survival.
Conclusions:
- An individual prediction model (IPM) can effectively stratify HCC risk in patients with chronic HBV infection.
- A tailored screening program incorporating IPM is crucial for early HCC detection and improved outcomes in high HBV endemic areas.
- Implementing effective screening systems for HCC, specifically for chronic hepatitis B patients, is necessary in endemic regions.
Abstract:
Hepatocellular carcinoma (HCC) is one of the major malignant diseases in Asia. Although no randomized controlled studies have demonstrated decreased mortalities, screening for HCC has become an accepted procedure in the high-risk population. Since the incidence of HCC is strikingly different according to geographical distribution of risk factors, especially chronic hepatitis B virus (HBV) infection, a surveillance strategy in high endemic areas should be established according to national conditions. Chronic necro-inflammation by persistent HBV infection per se can progress to cirrhosis and the occurrence of HCC. As in other chronic liver diseases, the more risk factors the chronic B viral patients have, the higher occurrence of HCC was shown. Based on the risk factors of 4,339 Korean patients, the individual prediction model (IPM) was made by the calculation of relative weighs of risk factors and a self-exploited screening program for HCC was established accordingly. US screening at 6-month intervals was beneficial for the early detection of HCC, especially in the high-risk group, and prolonged survival. The usefulness of a tailored screening program with IPM for HCC was prospectively confirmed. The effective screening system for diagnosis of HCC limited to patients with chronic hepatitis B might be necessitated in high endemic area.
