Objective: To study the variational trend in disease characteristics of patients with hepatitis B-related primary liver cancer (HBV-HCC) in the past five years. Method: A single-center retrospective cross-sectional analysis was performed to compare patients diagnosed with HBV-HCC from January 2012 to December 2016 (control group) and from January 2017 to December 2021 (observation group). The data of the study variables were extracted from the electronic medical record system of the hospital information system of the Second Hospital of Lanzhou University. The 1:2 propensity score matching was used to adjust potential confounding factors such as gender and age. Multivariate logistic regression analysis was used to study the factors affecting changes in disease characteristics of the HBV-HCC population in the observation group. GraphPad Prism 8.0 software was used to draw forest plots to intuitively display the effect size of the study variables in the logistic regression analysis.The t-test was used to compare normally distributed data between groups. The χ2 test was used for inter-group comparison. Results: A total of 1 717 eligible cases were collected, including 510 in the control group and 1 207 in the observation group. Compared with the control group, the number of newly diagnosed cases in the observation group increased by 2.36 times, and males were still the main onset population (83.3% vs. 82.7%). The median age of onset increased (51.9 vs. 53.5 years, P<0.001). 79.4% of HBV-HCC patients had not received antiviral therapy, and the proportion of HBeAg-negative patients increased (56.4%). The factors affecting HBV-HCC patients included family history of HBV (OR=1.626, 95%CI: 1.181-2.238), family history of hepatocellular carcinoma (OR=1.388, 95%CI: 1.013-1.901), hypoviremia (OR=1.322, 95%CI: 1.046-1.671), abnormal alanine aminotransferase (OR=1.545, 95%CI: 1.231-1.940), liver fibrosis (OR=1.478, 95%CI: 1.153-1.894), liver cirrhosis (OR=1.431, 95%CI: 1.128-1.815), and metabolic-related fatty liver disease (OR=1.438, 95%CI: 1.116-1.815) after propensity score matching adjustment. The factors affecting HBeAg-positive patients were decreased (OR=0.390, 95%CI: 0.389-0.617); however, the number of early HBV-HCC diagnoses was increased (12.7% vs. 19.3%, P=0.001). Conclusion: The characteristics of patient disease and occurrence of HBV-HCC are changing over the past five years. The risk of developing hepatocellular carcinoma in middle- to older male patients with chronic hepatitis B is increasing with familial history of HBV and hepatocellular carcinoma, HBeAg negativity, hypoviremia, abnormal alanine aminotransferase, liver fibrosis, cirrhosis, and metabolic-related fatty liver disease.
目的： 研究近5年乙型肝炎相关原发性肝细胞癌（HBV-HCC）患者疾病特征的变化趋势。 方法： 通过单中心横断面回顾性分析，对比2012年1月至2016年12月（对照组）与2017年1月至2021年12月（观察组）诊断为HBV-HCC的患者资料。研究变量资料从兰州大学第二医院的医院信息系统电子病例系统提取。采用1∶2倾向评分匹配调整性别和年龄等潜在混杂因素，利用多变量logistic回归分析研究观察组HBV-HCC人群疾病特征变化的影响因素，并采用GraphPad Prism 8.0软件绘制森林图显示logistic回归分析中研究变量的效应大小。计量正态分布资料组间比较用t检验；组间比较采用χ2检验。 结果： 共收集1 717例符合条件的患者资料，其中对照组510例，观察组1 207例。与对照组相比，观察组新确诊人数增加到2.36倍（1 207例/510例），男性仍为主要发病人群（83.3%比82.7%），发病中位年龄上升（51.9岁比53.5岁，P<0.001），79.4%的HBV-HCC患者未接受过抗病毒治疗，HBeAg阴性患者占比增多（56.4%）。倾向评分匹配调整后，影响HBV-HCC患者的因素包括：有HBV家族史（OR=1.626，95%CI：1.181～2.238）、有肝细胞癌家族史（OR=1.388，95%CI：1.013～1.901）、低病毒血症（OR=1.322，95%CI：1.046～1.671）、丙氨酸转氨酶异常（OR=1.545，95%CI：1.231～1.940）、肝纤维化（OR=1.478，95%CI：1.153～1.894）、肝硬化（OR=1.431，95%CI：1.128～1.815），以及代谢相关脂肪性肝病（OR=1.438，95%CI：1.116～1.815），HBeAg阳性患者影响因素减少（OR=0.390，95%CI：0.389～0.617）。然而，早期HBV-HCC诊断人数有所增加（12.7%比19.3%，P=0.001）。 结论： 近5年来，HBV-HCC患者的疾病特征正在发生变化。HBV和肝细胞癌家族史、HBeAg阴性、低病毒血症、丙氨酸转氨酶异常、肝纤维化、肝硬化以及代谢相关脂肪性肝病增加了中偏高年龄段男性慢性乙型肝炎患者发生肝细胞癌的风险。.