Prediction Model Of Liver Cancer In Patients With Hepatitis B Cirrhosis And The Preventive Effect Of Traditional Chinese Medicine On It

Hepatocellular carcinoma(HCC)has become the third most common cause of cancer-related death and one of the leading causes of death in patients with cirrhosis.Hepatitis B virus plays an important role in the development of Cirrhosis and HCC.Cirrhosis is the most major risk factor of HCC,70-90%of HCC patients have cirrhosis at the time of diagnosis,How to predict the occurrence of HCC accurately and take active intervention measures is of great significance to reduce the incidence of HCC.Therefore,it is important to identify the risk factors of HCC in patients with hepatitis B caused-cirrhosis(HBC),establish a predictive model to predict HCC risk,and closely follow up high-risk patients.Besides,the severity of liver fibrosis is another risk factor for HCC.Anti-fibrosis Chinese patent medicine can delay the occurrence of decompensated cirrhosis and prolong the survival of patients.Through the study of the effect of anti-fibrosis Chinese patent medicine on the occurrence of HCC in HBC patients,we provide a basis for clinical anti-fibrosis treatment of HBC patients and reducing HCC occurrence.OBJECTIVES1 To explore the risk factors of HCC in patients with HBC undergoing antiviral treatment during 3 years and establish a risk model.2 To investigate the effect of anti-fibrosis Chinese patent medicine on HCC occurrence in patients with HBC during 3 years.METHODS1 A total of 1461 patients with HBC diagnosed in Beijing Ditan Hospital Affiliated to Capital Medical University from October 2013 and April 2017 and followed up for more than 3 years were collected.We analyzed the risk factors of the 3-year occurrence of HCC and established a risk model of HCC in patients with HBC undergoing antiviral treatment.2 A total of 1461 patients with HBC diagnosed in Beijing Ditan Hospital Affiliated to Capital Medical University from October 2013 and April 2017 and followed up for more than 3 years were collected.After excluding the patients taking anti-fibrosis Chinese patent medicine for less than 6 months,1049 patients were included in the study.According to whether to use anti-fibrosis Chinese patent medicine for more than 6 months,patients were divided into combination group(388 cases)and antiviral group(661 cases).RESULTS1 The 3-year cumulative incidence rates of HCC were 10.2%in the derivation cohort and 11.5%in the validation cohort.Age,platelets,and neutrophil-lymphocyte ratio were independently associated with HCC using the multivariable Cox proportional hazard model.A new risk nomogram,named the APN model,was derived by assigning points for each covariate in proportion to the hazard ratios in the multivariable model(AUC=0.82).Compared with THRI,mPAGE-B,and PAGE-B models,the predictive value of the APN score was the strongest(all P<0.05).According to the 25th and 75th percentile of the score distribution(116 and 200 respectively),patients were divided into the low-risk group,medium risk group,and high-risk group.Patients with APN score?116,117-200,and>200 points had 3-year cumulative HCC inCIdence of 1.2%,7.9%,and 27.3%in the derivation and 1.2%,7.2%,and 25.8%in the validation cohorts.There was a significant difference in the inCIdence of HCC among the three groups(P<0.001).2 Through multivariable Cox regression analysis,anti-fibrosis treatment is an independent protective factor for the prevention of HCC occurrence in patients with HBC in three years(P<0.05).Anti-fibrosis Chinese patent medicine treatment can significantly reduce the 3-year risk of HCC in patients with HBC.The incidence of HCC occurrence in the combination group was lower than that in the antiviral group(10.3%vs 15.4%,P<0.05).According to the further analysis of medication time,the longer the medication time,the lower the incidence of HCC occurrence(P=0.003).Child-Pugh stage analysis showed that the risk of HCC in patients with Child-Pugh A was significantly reduced(6.6%vs 12.5%,P=0.040).The incidence of HCC in the combination group was significantly lower than that in the antiviral group in patients with high risk in mPAGE-B model(13.7%vs 19.9%,P=0.031).CONCLUSION1 Baseline age,platelet,and neutrophil-lymphocyte ratio were independent risk factors of HCC in patients with HBC undergoing antiviral treatment in 3 years.The APN model based on risk factors can well identify the high-risk groups of HCC occurrence.2 Taking anti-fibrosis Chinese patent medicine in patients with HBCcan reduce the risk of HBC during 3 years.The longer takes anti-fibrosis Chinese patent medicine,the lower the incidence of HCC occurrence.The study also found that the prevention effect is the most obvious for patients with child Pugh A and with high risk in mPAGE-B model and risk.