52
|
Wong VWS, Chan SL, Mo F, Chan TC, Loong HHF, Wong GLH, Lui YYN, Chan ATC, Sung JJY, Yeo W, Chan HLY, Mok TSK. Clinical Scoring System to Predict Hepatocellular Carcinoma in Chronic Hepatitis B Carriers. J Clin Oncol 2010; 28:1660-5. [DOI: 10.1200/jco.2009.26.2675] [Citation(s) in RCA: 368] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Hepatitis B virus (HBV) infection is an important etiology for hepatocellular carcinoma (HCC). We aim to develop a simple clinical score in predicting the risk of HCC among HBV carriers. Patients and Methods We first evaluated 1,005 patients and found that the following five factors independently predicted HCC development: age, albumin, bilirubin, HBV DNA, and cirrhosis. These variables were used to construct a prediction score ranging from 0 to 44.5. The score was validated in another prospective cohort of 424 patients. Results During a median follow-up of 10 years, 105 patients (10.%) in the training cohort and 45 patients (10.6%) in the validation cohort developed HCC. Cutoff values of 5 and 20 best discriminated HCC risk. By applying the cutoff value of 5, the score excluded future HCC development with high accuracy (negative predictive value = 97.8% and 97.3% in the training and validation cohorts, respectively). In the validation cohort, the 5-year HCC-free survival rates were 98.3%, 90.5%, and 78.9% in the low-, medium-, and high-risk groups, respectively. The hazard ratios for HCC in the medium- and high-risk groups were 12.8 and 14.6, respectively. Conclusion A simple prediction score constructed from routine clinical and laboratory parameters is accurate in predicting HCC development in HBV carriers. Future prospective validation is warranted.
Collapse
Affiliation(s)
- Vincent Wai-Sun Wong
- From the Department of Medicine and Therapeutics and Institute of Digestive Disease, Chinese University of Hong Kong; State Key Laboratory in Oncology in South China, Department of Clinical Oncology, Sir YK Pao Center for Cancer; Hong Kong Cancer Institute; and Prince of Wales Hospital, Hong Kong, China
| | - Stephen Lam Chan
- From the Department of Medicine and Therapeutics and Institute of Digestive Disease, Chinese University of Hong Kong; State Key Laboratory in Oncology in South China, Department of Clinical Oncology, Sir YK Pao Center for Cancer; Hong Kong Cancer Institute; and Prince of Wales Hospital, Hong Kong, China
| | - Frankie Mo
- From the Department of Medicine and Therapeutics and Institute of Digestive Disease, Chinese University of Hong Kong; State Key Laboratory in Oncology in South China, Department of Clinical Oncology, Sir YK Pao Center for Cancer; Hong Kong Cancer Institute; and Prince of Wales Hospital, Hong Kong, China
| | - Tung-Ching Chan
- From the Department of Medicine and Therapeutics and Institute of Digestive Disease, Chinese University of Hong Kong; State Key Laboratory in Oncology in South China, Department of Clinical Oncology, Sir YK Pao Center for Cancer; Hong Kong Cancer Institute; and Prince of Wales Hospital, Hong Kong, China
| | - Herbert Ho-Fung Loong
- From the Department of Medicine and Therapeutics and Institute of Digestive Disease, Chinese University of Hong Kong; State Key Laboratory in Oncology in South China, Department of Clinical Oncology, Sir YK Pao Center for Cancer; Hong Kong Cancer Institute; and Prince of Wales Hospital, Hong Kong, China
| | - Grace Lai-Hung Wong
- From the Department of Medicine and Therapeutics and Institute of Digestive Disease, Chinese University of Hong Kong; State Key Laboratory in Oncology in South China, Department of Clinical Oncology, Sir YK Pao Center for Cancer; Hong Kong Cancer Institute; and Prince of Wales Hospital, Hong Kong, China
| | - Yanni Yan-Ni Lui
- From the Department of Medicine and Therapeutics and Institute of Digestive Disease, Chinese University of Hong Kong; State Key Laboratory in Oncology in South China, Department of Clinical Oncology, Sir YK Pao Center for Cancer; Hong Kong Cancer Institute; and Prince of Wales Hospital, Hong Kong, China
| | - Anthony Tak-Cheung Chan
- From the Department of Medicine and Therapeutics and Institute of Digestive Disease, Chinese University of Hong Kong; State Key Laboratory in Oncology in South China, Department of Clinical Oncology, Sir YK Pao Center for Cancer; Hong Kong Cancer Institute; and Prince of Wales Hospital, Hong Kong, China
| | - Joseph Jao-Yiu Sung
- From the Department of Medicine and Therapeutics and Institute of Digestive Disease, Chinese University of Hong Kong; State Key Laboratory in Oncology in South China, Department of Clinical Oncology, Sir YK Pao Center for Cancer; Hong Kong Cancer Institute; and Prince of Wales Hospital, Hong Kong, China
| | - Winnie Yeo
- From the Department of Medicine and Therapeutics and Institute of Digestive Disease, Chinese University of Hong Kong; State Key Laboratory in Oncology in South China, Department of Clinical Oncology, Sir YK Pao Center for Cancer; Hong Kong Cancer Institute; and Prince of Wales Hospital, Hong Kong, China
| | - Henry Lik-Yuen Chan
- From the Department of Medicine and Therapeutics and Institute of Digestive Disease, Chinese University of Hong Kong; State Key Laboratory in Oncology in South China, Department of Clinical Oncology, Sir YK Pao Center for Cancer; Hong Kong Cancer Institute; and Prince of Wales Hospital, Hong Kong, China
| | - Tony Shu-Kam Mok
- From the Department of Medicine and Therapeutics and Institute of Digestive Disease, Chinese University of Hong Kong; State Key Laboratory in Oncology in South China, Department of Clinical Oncology, Sir YK Pao Center for Cancer; Hong Kong Cancer Institute; and Prince of Wales Hospital, Hong Kong, China
| |
Collapse
|
53
|
Abstract
Among approximately 650,000 people who die from hepatocellular carcinoma (HCC) each year, at least two-thirds live in Asia. Efforts to improve early diagnosis and treatment have not yet impacted mortality. An Asia-Pacific Working Party convened in Hong Kong in June 2008 to consider ways to prevent HCC in this region. Separate reviews have summarized epidemiology of HCC, preventive approaches related to hepatitis B virus (HBV), hepatitis C virus (HCV) and non-viral liver diseases, and the role of surveillance to detect HCC at a curative stage. We now present Consensus Statements from these deliberations and reviews. As chronic hepatitis B is the most common cause of HCC in Asia, effective hepatitis B vaccination programs are the most important strategy to reduce HCC incidence. Prevention of HCV by screening blood donors, universal precautions against blood contamination in health-care settings and reducing HCV transmission from injection drug use are also vital. There is strong evidence that effective antiviral therapy to control HBV infection or eradicate HCV substantially reduces (but does not abolish) HCC risk. With hemochromatosis, family screening, early diagnosis and correcting iron overload to prevent liver fibrosis prevents HCC. There is currently insufficient evidence to give firm recommendations on alcohol, obesity/metabolic risk factors and other liver diseases. HCC surveillance for high-risk groups is recommended in individual cases but cost-effectiveness is not as high as infant hepatitis B vaccination and screening blood for HCV. Widespread application of HCC surveillance in Asia-Pacific countries depends on economic factors and health-care priorities.
Collapse
MESH Headings
- Antiviral Agents/therapeutic use
- Asia
- Australia
- Carcinoma, Hepatocellular/diagnosis
- Carcinoma, Hepatocellular/etiology
- Carcinoma, Hepatocellular/prevention & control
- Comorbidity
- Disease Progression
- Early Detection of Cancer
- Evidence-Based Medicine
- Hemochromatosis/complications
- Hemochromatosis/diagnosis
- Hemochromatosis/therapy
- Hepatitis B Vaccines
- Hepatitis B, Chronic/complications
- Hepatitis B, Chronic/diagnosis
- Hepatitis B, Chronic/prevention & control
- Hepatitis B, Chronic/transmission
- Hepatitis C, Chronic/complications
- Hepatitis C, Chronic/diagnosis
- Hepatitis C, Chronic/prevention & control
- Hepatitis C, Chronic/transmission
- Humans
- Infection Control
- Liver Neoplasms/diagnosis
- Liver Neoplasms/etiology
- Liver Neoplasms/prevention & control
- Mass Screening/methods
- Primary Prevention
- Risk Assessment
- Risk Factors
- Secondary Prevention
Collapse
|
55
|
Abstract
Although chronic infection with hepatitis B virus and/or hepatitis C virus are the most important risk factors for hepatocellular carcinoma (HCC) worldwide, other causes of cirrhosis can also lead to HCC. Given the high prevalence of alcoholism and the worldwide obesity epidemic, the relevant importance of nonviral liver disease-related HCC is expected to increase in the future. Some evidence supports mechanistic interactions between host or environmental factors and chronic viral hepatitis in the development of HCC. For example, food- and water-borne carcinogens have contributed to unusually high rates of HCC in parts of China and sub-Saharan Africa. With some of these conditions, appropriate public health measures to reduce the population's exposure to known etiologic agents, or early therapeutic intervention for 'at-risk' individuals before development of cirrhosis (e.g. hereditary hemochromatosis) can prevent HCC. Community-based programs to discourage and deal with excessive alcohol intake, to promote tobacco smoking awareness, to avoid exposure to aflatoxin and other food toxins, and measures to reduce the pandemic of obesity and diabetes are vital for effective interruption of the rising tide of HCC from nonviral liver disease.
Collapse
Affiliation(s)
- Jian-Gao Fan
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | | | | |
Collapse
|