ABSTRACT
Background/Aims@#Existing hepatocellular carcinoma (HCC) prediction models are derived mainly from pretreatment or early on-treatment parameters. We reassessed the dynamic changes in the performance of 17 HCC models in patients with chronic hepatitis B (CHB) during long-term antiviral therapy (AVT). @*Methods@#Among 987 CHB patients administered long-term entecavir therapy, 660 patients had 8 years of follow-up data. Model scores were calculated using on-treatment values at 2.5, 3, 3.5, 4, 4.5, and 5 years of AVT to predict threeyear HCC occurrence. Model performance was assessed with the area under the receiver operating curve (AUROC). The original model cutoffs to distinguish different levels of HCC risk were evaluated by the log-rank test. @*Results@#The AUROCs of the 17 HCC models varied from 0.51 to 0.78 when using on-treatment scores from years 2.5 to 5. Models with a cirrhosis variable showed numerically higher AUROCs (pooled at 0.65–0.73 for treated, untreated, or mixed treatment models) than models without (treated or mixed models: 0.61–0.68; untreated models: 0.51–0.59). Stratification into low, intermediate, and high-risk levels using the original cutoff values could no longer reflect the true HCC incidence using scores after 3.5 years of AVT for models without cirrhosis and after 4 years of AVT for models with cirrhosis. @*Conclusions@#The performance of existing HCC prediction models, especially models without the cirrhosis variable, decreased in CHB patients on long-term AVT. The optimization of existing models or the development of novel models for better HCC prediction during long-term AVT is warranted.
ABSTRACT
The evolution concept of decompensated cirrhosis rebuilds the clinical staging system for decompensated cirrhosis, which changes the focus from the pattern of disease progression to refining the status of acute decompensation onset and proposing "recompensation" of decompensated cirrhosis. During the process, factors such as portal hypertension and systemic inflammatory changes can affect the clinical outcome of decompensated cirrhotic patients. Significantly, more evidence is warranted to elucidate the clinical characteristics and potential mechanisms of achieving "recompensation" after etiology control, such as in viral hepatitis patients.
ABSTRACT
At present, albumin is mainly used to prevent post-paracentesis circulatory dysfunction in patients with cirrhotic ascites, prevent renal dysfunction in patients with spontaneous peritonitis, and treat hepatorenal syndrome. Recent studies have shown that long-term albumin treatment can reduce the incidence rate of complications and improve overall prognosis in patients with cirrhotic ascites, which brings new insights into the indication for clinical application of albumin. This article reviews the clinical studies on the long-term administration of albumin in patients with cirrhotic ascites, aiming to provide evidence-based advice for further clinical research on long-term application of albumin in China.
ABSTRACT
An increasing number of clinical studies have shown that effective etiological therapy might achieve the reversal of liver fibrosis/early cirrhosis. An accurate assessment of fibrosis reversal is of great importance for treatment decision-making and prognosis prediction. At present, the “gold standard” for the histological evaluation of liver fibrosis/cirrhosis reversal remains to be perfected, and there is still a controversy over the noninvasive assessment of fibrosis reversal. Long-term cohort studies are needed to observe whether it can improve clinical hard endpoint, and the clinical effect of new anti-fibrotic drugs needs to be further confirmed.
ABSTRACT
Achieving HBV DNA negative transformation and HBsAg clearance with effective antiviral therapy can reduce the incidence of HCC, but some patients are still at risk of developing HCC. Therefore, screening high-risk patients for close monitoring is essential to reduce the incidence of HCC. This paper reviews the occurrence of HCC, risk factors and risk prediction models of HBV DNA negative transformation and HBsAg clearance, and provides a basis for screening and follow-up management of high-risk group of HCC with chronic hepatitis B.
ABSTRACT
Liver cirrhosis is the end stage of chronic liver disease and as the disease progresses to decompensated stage cirrhosis, the mortality rate of patients’ increases significantly. The goal of controlling the etiology or treatment in decompensated stage cirrhosis is to improve the liver function of patients, stabilize the disease condition or reverse decompensation, reduce the recurrence of decompensated events and reduce the mortality rate. However, presently, there are few studies on the reversal of cirrhotic decompensation/ re-compensation. Moreover, the effect of prophylactic treatment on re-compensation, evaluation indicators and duration of re-compensation, structure of hepatic lobules and whether microvessels can be reconstructed are unclear, so require further research.
ABSTRACT
Liver fibrosis/cirrhosis is a common pathological outcome of chronic hepatic diseases, and an accurate assessment of the degree of liver fibrosis has an important reference value in a definite diagnosis, treatment decision-making, clinical outcome monitoring, and prognostic evaluation. Two quantitative assessment techniques are widely used at present: the quantitative assessment technique based on liver biopsy is the gold standard for identifying the exact liver fibrosis stage and evaluating the progression and reversion of liver fibrosis; the noninvasive quantitative assessment technique based on imaging technology plays an important role in dynamic monitoring and prognostic prediction of liver fibrosis due to its repeatability. This article summarizes the development and application of these two quantitative assessment techniques to provide guidance for clinical practice.