HBsAg 血清清除后的肝细胞癌监测

J. Lai, Vicki Wing-Ki Hui, G. Wong, V. W. Wong, T. Yip
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摘要

乙型肝炎表面抗原(HBsAg)血清清除被认为是慢性乙型肝炎(CHB)的功能性治愈和最佳治疗终点。清除了 HBsAg 的慢性乙型肝炎患者一般临床疗程良好,发生肝细胞癌(HCC)或肝硬化并发症的风险极低。然而,少数患者尽管清除了 HBsAg 血清,但仍会发展为 HCC。虽然肝硬化患者仍被建议接受 HCC 监控,但其他非肝硬化患者在 HBsAg 血清清除后是否仍应继续接受 HCC 监控仍不明确。本综述概述了 HBsAg 血清清除的发生率、发生 HBsAg 血清清除的相关因素、HBsAg 血清清除的持久性、HBsAg 血清清除后发展为 HCC 的风险、HBsAg 血清清除后发展为 HCC 的相关风险因素、HCC 风险评分的作用以及对 HCC 监测的影响。现有的 HCC 风险评分在 HBsAg 血清清除后的患者中具有相当好的表现。在人工智能时代,未来基于人工智能和纵向临床数据的 HCC 风险预测模型可能会进一步提高预测的准确性,从而为基于风险评分的 HCC 监测策略奠定基础。随着以清除 HBsAg 为目标的各种新型乙型肝炎病毒(HBV)抗病毒药物正在积极开发中,人们期待着对接受新型 HBV 药物治疗的患者的自然病史和 HCC 风险预测有新的认识。
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Hepatocellular carcinoma surveillance after HBsAg seroclearance
Hepatitis B surface antigen (HBsAg) seroclearance is considered the functional cure and the optimal treatment endpoint for chronic hepatitis B (CHB). Patients with CHB who cleared HBsAg generally have a favorable clinical course with minimal risk of developing hepatocellular carcinoma (HCC) or cirrhotic complications. Nevertheless, a minority of patients still develop HCC despite HBsAg seroclearance. While patients with liver cirrhosis are still recommended for HCC surveillance, whether other non-cirrhotic patients who achieved HBsAg seroclearance should remain on HCC surveillance remains unclear. This review provides an overview of the incidence of HBsAg seroclearance, the factors associated with the occurrence of HBsAg seroclearance, the durability of HBsAg seroclearance, the risk of developing HCC after HBsAg seroclearance, the risk factors associated with HCC development after HBsAg seroclearance, the role of HCC risk scores, and the implications on HCC surveillance. Existing HCC risk scores have a reasonably good performance in patients after HBsAg seroclearance. In the era of artificial intelligence, future HCC risk prediction models based on artificial intelligence and longitudinal clinical data may further improve the prediction accuracy to establish a foundation of a risk score-based HCC surveillance strategy. As different novel hepatitis B virus (HBV) antiviral agents aiming at HBsAg seroclearance are under active development, new knowledge is anticipated on the natural history and HCC risk prediction of patients treated with new HBV drugs.
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