Association of P-I-R classification and Laennec grading with histology and prognosis after antiviral therapy in patients with hepatitis B cirrhosis / 临床肝胆病杂志

ABSTRACT

Objective To investigate the role of P-I-R classification and Laennec grading in evaluating histological changes in patients with hepatitis B cirrhosis after receiving antiviral therapy, as well as the association of these two evaluation systems with clinical prognosis. Methods A total of 218 patients from 14 centers were consecutively screened from October 2013 to October 2014, and these patients were diagnosed with liver cirrhosis based on pathology (Ishak score ≥5), received antiviral therapy for 72 weeks, completed two liver biopsies, and met the P-I-R classification criteria. The 218 patients were divided into non-hepatocellular carcinoma (HCC) group with 186 patients and HCC group with 32 patients. The chi-square test and the Fisher's exact test were used for comparison of categorical data between groups. For the comparison of HCC after antiviral therapy, the non-parametric Mann-Whitney U test was used for continuous variables, and for the comparison of P-I-R classification and Laennec grading, the non-parametric Kruskal-Wallis H test was used for continuous variables. Univariate and multivariate Cox regression analyses were used to calculate hazard ratio ( HR ) and 95% confidence interval ( CI ), and the Kaplan-Meier method was used to calculate the cumulative incidence rate of HCC. Results After 72 weeks of antiviral therapy, there was a significant difference in P-I-R classification between the non-HCC group and the HCC group ( P < 0.001). There were significant differences in the distribution of Laennec grading and P-I-R classification before and after antiviral therapy ( P < 0.001). After antiviral therapy, the 218 patients were divided into 4A group with 33 patients, 4B group with 71 patients, and 4C group with 114 patients according to Laennec grading, and there were significant differences between these three groups in platelet count (PLT) ( H =36.429, P < 0.001), liver stiffness measurement (LSM) ( H =13.983, P =0.004), Ishak score ( χ 2 =23.060, P < 0.001), and HAI score ( P < 0.001). After antiviral therapy, the 218 patients were divided into R group with 70 patients, I group with 52 patients, and P group with 96 patients according to P-I-R classification, and there were significant differences between these three groups in PLT ( H =7.193, P =0.028), LSM ( H =6.238, P =0.045), Ishak score ( χ 2 =7.986, P < 0.001), HAI score ( P =0.002), and HCC ( P < 0.001). There was a significant difference in the incidence rate of HCC between the P and R groups based on P-I-R classification ( HR =24.21, 95% CI 0.46-177.99, P =0.002). After adjustment for other confounding factors, P-I-R classification was an independent predictive factor for HCC ( HR =12.69, 95% CI 4.63-34.80, P =0.002). Conclusion Both P-I-R classification and Laennec grading can reflect the features and changes of fibrosis before and after antiviral therapy, and P-I-R classification is more sensitive to fibrosis changes after antiviral therapy. P-I-R classification (after treatment) can be used to assess the risk of HCC in patients after antiviral therapy.