HCC-4风险评分可识别易癌变的丙肝患者

根据《欧洲内科学杂志》在线发表的一项回顾性研究，HCC-4——一种基于常规检测结果的风险评分——可能有助于识别最可能进展为肝细胞癌的慢性丙型肝炎患者(Eur. J. Intern. Med. 2013 July 12 [doi: 10.1016/j.ejim.2013.06.010])。

西班牙Virgin de la Victoria大学医院的Juan Carlos Gavilan医生报告称，借助这套评分，临床医生得以针对最高危患者开展恶性肝脏结节监测。鉴于现行筛查方法因具有一定侵入性、费用较高、效能较低而难以在所有危险人群中广泛使用，这套评分具有重要价值。这种新的风险评分还可能有助于识别癌变风险最低的慢性丙型肝炎患者，从而使其安心地不接受监测。



研究者对一项为期17年、纳入829例慢性丙型肝炎患者的纵向队列研究数据进行了回顾性分析。这些受试者每6个月接受1次评估，利用血清甲胎蛋白(AFP)水平和超声影像筛查肝细胞癌。结果共有58例患者(7%)在随访期间发生肝细胞癌。

在最初的单变量分析中，研究者找出了多个与肝细胞癌风险升高相关的临床和流行病学因素，并利用其中4项最强因素(年龄、血小板计数、γ球蛋白水平，以及基线时AFP水平)构建了一个预测公式——HCC-4风险评分。

Gavilan医生及其同事根据这一预测公式将受试者分为低危、中危和高危三分位，然后分析发现，低危组、中危组和高危组的肝细胞癌年发病率分别为0.06%、0.5%和2.6%，提示HCC-4风险评分具有很高的预测准确度。他们指出，事实上该评分预测肝细胞癌的准确度优于目前常用的纤维化指数。

根据最近发表的指南建议，只有肝细胞癌年发病风险≥1.5%的患者才应当接受监测。因此，被HCC-4风险评分识别为高危的患者应当接受此类监测，而中危或低危患者则不需要。

研究者承认，上述结果仍有待其他研究的验证。

该研究未接受外部资助，研究者无利益冲突披露。

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By: MARY ANN MOON, Oncology Practice

A risk score derived from four simple test results readily obtained during routine care may help identify the patients with chronic hepatitis C who are most at risk for developing hepatocellular carcinoma, according to a retrospective study published online July 12 in the European Journal of Internal Medicine.

The score could enable physicians to target only the highest-risk patients for annual surveillance for malignant hepatic nodules, which is crucial because current screening methods are too invasive, too expensive, and too low-yield to be applied broadly across all risk groups.

The new risk score also may help identify patients with chronic hepatitis C who are at lowest risk for developing HCC, who can then be reassured that they can safely forgo invasive and expensive surveillance, reported Dr. Juan Carlos Gavilan and his associates at University Hospital Virgin de la Victoria, Malaga (Spain).
 
The investigators reviewed data from a 17-year longitudinal cohort study involving 829 patients with chronic hepatitis C. These subjects were assessed every 6 months for the development of HCC using serum alpha-fetoprotein (AFP) levels and ultrasound imaging to detect new focal hepatic lesions.

A total of 58 subjects (7%) developed HCC during follow-up.

An initial univariate analysis identified numerous clinical and epidemiologic factors associated with elevated risk for HCC. The researchers constructed a formula for predicting risk using the four independent factors that were most predictive of HCC in this cohort: patient age, platelet count, gamma-globulin level, and AFP level at baseline.

By dividing the study population into tertiles, Dr. Gavilan and his colleagues established cutoff ranges for low, medium, and high risk. They then classified each study participant as belonging to one of these three categories, to see how well this risk score correlated with the actual rates of HCC.

The annual incidence of HCC was 0.06% in the group designated as low risk, 0.5% in the group designated as medium risk, and 2.6% in the group designated as high risk, indicating that this "HCC-4 risk score" was indeed highly predictive, Dr. Gavilan and his associates said (Eur. J. Intern. Med. 2013 July 12 [doi: 10.1016/j.ejim.2013.06.010]).

In fact, the score was more accurate at predicting HCC than was the commonly used fibrosis index, they noted.

According to recently published recommendations, surveillance is only justified in populations with an HCC incidence of 1.5% or more per year. Thus, patients found to be high risk using this HCC-4 risk score would be appropriate for such surveillance, while those at medium or low risk would not be.

"These results must be confirmed in other studies," the investigators said.

There was no external funding source for this study, and no financial conflicts of interest were reported.