| Objective To study the incidence rate and predictors of hepatocellular carcinoma?HCC?in patients with CHB?Chronic Hepatitis B viral hepatitis,CHB?receiving entecavir?ETV?treatment,and to investigate the effect of ETV antiviral therapy on the incidence rate of HCC.Methods A case-countrol study was carried out.Atotal of 344 patients with CHB had received treatment with ETV?0.5mg daily?for at least 6 months.All the patients were hospitalized in the first people's Hospital of Zhangjiagang from January 2010 to March2012.Data were analysed using the statistical package SPSS 20.0.The significant levelwas?=0.05.Continuous variables were presented by their mean valuesąstandard deviation?SD?.The t-test was presented for pairwise comparison.The count data was presented by rate and percentage.The?2 test was used to compare the difference between groups.The Kaplan-meier method was used to calculate probability of HCC occurrence in patients with chronic hepatitis B at different age groups,platelet count levels and HBeAg status after 1,3,5 years of ETV treatment.Univariable and inmultivariable Cox proportional hazards models were used to analyze the predictors of HCC in the follow-up period.Results?1?The cumulative probability of HCC in 344 patients was 2.91%at year-1,5.81%at year-3,8.43%at year-5 after ETV.?2?The 1-,3-,and 5-year cumulative HCC rates were 1.22%,1.22%and 2.44%for patients with CHB without cirrhosis,2.90%,10.15%and 15.94%for patients with compensated cirrhosis and 16.67%,33.33%and 40.0%for patients with decompensated cirrhosis.?3?The 1-,3-,and 5-year cumulative HCC rates were 1.19%,1.59%and 2.38%for patients under 50 years old,and 6.58%,17.11%and 23.68%for patients aged 50-60 years old and 12.50%,18.75%and 31.25%for patients over 60 years old.?4?The 1-,3-,and 5-year cumulative HCC rates were 4.44%,12.22%,18.89%for patients with platelet count<100*10^9/L and 2.49%,3.73%,4.98%for patients with platelet count?100*10^9/L.?5?The 1-,3-,and 5-year cumulative HCC rates were 0.61%,1.83%,3.05%in HBeAg positive patients and 5.0%,9.44%,13.33%in HBeAg negative patients.?6?In univariable Cox proportional hazards regression analyses,older age?HR=1.11,95%CI:1.071.15?,HBeAg negative?HR=4.57,95%CI:1.7411.98?,lower platelet count?HR=3.95,95%CI:1.898.27?,compensated cirrhosis?HR=6.84,95%CI:2.5318.49?,decompensated cirrhosis?HR=19.55,95%CI:7.3352.19?were found to be predictors of HCC development in the total patients.For non-cirrhotic patients,older age?HR=1.08,95%CI:1.001.17?and lower albumin level?HR=1.11,95%CI:1.031.18?were predictors of HCC.For cirrhosis populations,older age?HR=1.08,95%CI:1.031.14?and decompensated cirrhosis?HR=2.86,95%CI:1.266.49?were predictors of HCC.In multivariable Cox proportional hazards regression analyses,age of 5060years?vs<50 years old?,compensated cirrhosis and decompensated cirrhosis were found to be predictors of HCC development in the total patient population.For non-cirrhotic patients,older age and lower albumin level were predictors of HCC.For cirrhosis patients,the age of over 50 years was a predictor of HCC.Conclusions 1.HCC can still develop in patients with CHB,despite the treatment with long term oral ETV.2.Besides the well-known predictors of HCC,older age,cirrhosis,HBeAg negative and low platelet can also represent a higher factor of higher HCC risk.3.For male patients older than 50 years,especially those with HBeAg negative patients,should be regularly monitored,which was beneficial to early detection of HCC,so as to improve the prognosis of patients. |
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