한빛사논문
Abstract
Hyo Jung Cho MD, PhD1,4, Bohyun Kim MD, PhD2,4, Jung-Dong Lee MS3, Dae Ryong Kang PhD3, Jai Keun Kim MD, PhD2, Jei Hee Lee MD, PhD2, Sung Jae Shin MD, PhD1, Kee Myung Lee MD, PhD1, Byung Moo Yoo MD, PhD1, Kwang Jae Lee MD, PhD1, Soon Sun Kim MD, PhD1, Jae Youn Cheong MD, PhD1 and Sung Won Cho MD, PhD1,*
1Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
2Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
3Office of Biostatistics, Ajou University School of Medicine, Suwon, South Korea
4The first two authors contributed equally to this work
*Correspondence: Sung Won Cho, MD, PhD, Department of Gastroenterology, Ajou University School of Medicine, Worldcup-ro 164, Yeongtong-Gu, Suwon 443-380, South Korea.
Abstract
OBJECTIVES: This study was performed to evaluate long-term outcome of indeterminate nodules detected on cirrhotic liver and to develop risk prediction model for hepatocellular carcinoma (HCC) progression of indeterminate nodules on hepatitis B virus (HBV)-related cirrhotic liver.
METHODS: Indeterminate nodules up to 2 cm with uncertain malignant potential detected on computed tomography of cirrhotic liver during HCC surveillance were analyzed retrospectively. HCC risk prediction model of indeterminate nodules in HBV-related cirrhotic liver was deduced based on result of Cox regression analysis.
RESULTS: A total of 494 indeterminate nodules were included. Independent risk factors of HCC progression were old age, arterial enhancement, large nodule size, low serum albumin level, high serum α-fetoprotein (AFP) level, and prior HCC history in all included subjects. In subjects with chronic hepatitis B, old age (year; hazard ratio (HR)=1.06; P<0.001), arterial enhancement (HR=2.62; P=0.005), large nodule size (>1 cm; HR=7.34; P<0.001), low serum albumin level (≤3.5 g/dl; HR=3.57; P=0.001), high serum AFP level (≥100 ng/ml; HR=6.04; P=0.006), prior HCC history (HR=4.24; P=0.001), and baseline hepatitis B e antigen positivity (HR=2.31; P=0.007) were associated with HCC progression. We developed a simple risk prediction model using these risk factors and identified patients at low, intermediate, and high risk for HCC; 5-year cumulative incidences were 1%, 14.5%, and 63.1%, respectively. The developed risk score model showed good performance with area under the curve at 0.886 at 3 years, and 0.920 at 5 years in leave-one-out cross-validation.
CONCLUSIONS: We developed a useful and accurate risk score model for predicting HCC progression of indeterminate nodules detected on HBV-related cirrhotic liver.
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