The utility of P-I-R classification in predicting the on-treatment histological and clinical outcomes of patients with hepatitis B and advanced liver fibrosis
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc..
BACKGROUND AND AIMS: The predominantly progressive, indeterminate, and predominantly regressive (P-I-R) classification extends beyond staging and provides information on dynamic changes of liver fibrosis. However, the prognostic implication of P-I-R classification is not elucidated. Therefore, in the present research, we investigated the utility of P-I-R classification in predicting the on-treatment clinical outcomes.
APPROACH AND RESULTS: In an extension study on a randomized controlled trial, we originally enrolled 1000 patients with chronic hepatitis B and biopsy-proven histological significant fibrosis, and treated them for more than 7 years with entecavir-based therapy. Among the 727 patients with a second biopsy at treatment week 72, we compared P-I-R classification and Ishak score changes in 646 patients with adequate liver sections for the histological evaluation. Progressive, indeterminate, and regressive cases were observed in 70%, 17%, and 13% of patients before treatments and 20%, 14%, and 64% after 72-week treatment, respectively, which could further differentiate the histological outcomes of patients with stable Ishak scores. The 7-year cumulative incidence of HCC was 1.5% for the regressive cases, 4.3% for the indeterminate cases, and 22.8% for the progressive cases ( p <0.001). After adjusting for age, treatment regimen, platelet counts, cirrhosis, Ishak fibrosis score changes, and Laennec staging, the posttreatment progressive had a HR of 17.77 (vs. posttreatment regressive; 95% CI: 5.55-56.88) for the incidence of liver-related events (decompensation, HCC, and death/liver transplantation).
CONCLUSIONS: The P-I-R classification can be a meaningful complement to the Ishak fibrosis score not only in evaluating the histological changes but also in predicting the clinical outcomes.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:79 |
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| Enthalten in: |
Hepatology (Baltimore, Md.) - 79(2024), 2 vom: 01. Feb., Seite 425-437 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Chang, Xiujuan [VerfasserIn] |
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| Anmerkungen: |
Date Completed 18.01.2024 Date Revised 13.02.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1097/HEP.0000000000000563 |
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| Förderinstitution / Projekttitel: |
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NLM361096976 |
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| 100 | 1 | |a Chang, Xiujuan |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The utility of P-I-R classification in predicting the on-treatment histological and clinical outcomes of patients with hepatitis B and advanced liver fibrosis |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. | ||
| 520 | |a BACKGROUND AND AIMS: The predominantly progressive, indeterminate, and predominantly regressive (P-I-R) classification extends beyond staging and provides information on dynamic changes of liver fibrosis. However, the prognostic implication of P-I-R classification is not elucidated. Therefore, in the present research, we investigated the utility of P-I-R classification in predicting the on-treatment clinical outcomes | ||
| 520 | |a APPROACH AND RESULTS: In an extension study on a randomized controlled trial, we originally enrolled 1000 patients with chronic hepatitis B and biopsy-proven histological significant fibrosis, and treated them for more than 7 years with entecavir-based therapy. Among the 727 patients with a second biopsy at treatment week 72, we compared P-I-R classification and Ishak score changes in 646 patients with adequate liver sections for the histological evaluation. Progressive, indeterminate, and regressive cases were observed in 70%, 17%, and 13% of patients before treatments and 20%, 14%, and 64% after 72-week treatment, respectively, which could further differentiate the histological outcomes of patients with stable Ishak scores. The 7-year cumulative incidence of HCC was 1.5% for the regressive cases, 4.3% for the indeterminate cases, and 22.8% for the progressive cases ( p <0.001). After adjusting for age, treatment regimen, platelet counts, cirrhosis, Ishak fibrosis score changes, and Laennec staging, the posttreatment progressive had a HR of 17.77 (vs. posttreatment regressive; 95% CI: 5.55-56.88) for the incidence of liver-related events (decompensation, HCC, and death/liver transplantation) | ||
| 520 | |a CONCLUSIONS: The P-I-R classification can be a meaningful complement to the Ishak fibrosis score not only in evaluating the histological changes but also in predicting the clinical outcomes | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Antiviral Agents |2 NLM | |
| 700 | 1 | |a Lv, Caihong |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Bingqiong |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Jing |e verfasserin |4 aut | |
| 700 | 1 | |a Song, Zheng |e verfasserin |4 aut | |
| 700 | 1 | |a An, Linjing |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Shuyan |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Yongping |e verfasserin |4 aut | |
| 700 | 1 | |a Shang, Qinghua |e verfasserin |4 aut | |
| 700 | 1 | |a Yu, Zujiang |e verfasserin |4 aut | |
| 700 | 1 | |a Tan, Lin |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Qin |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Huabao |e verfasserin |4 aut | |
| 700 | 1 | |a Jiang, Li |e verfasserin |4 aut | |
| 700 | 1 | |a Xiao, Guangming |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Liang |e verfasserin |4 aut | |
| 700 | 1 | |a Lu, Wei |e verfasserin |4 aut | |
| 700 | 1 | |a Hu, Xiaoyu |e verfasserin |4 aut | |
| 700 | 1 | |a Dong, Zheng |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Yan |e verfasserin |4 aut | |
| 700 | 1 | |a Sun, Yameng |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Xiaodong |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Zhiqin |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Da |e verfasserin |4 aut | |
| 700 | 1 | |a You, Hong |e verfasserin |4 aut | |
| 700 | 1 | |a Jia, Jidong |e verfasserin |4 aut | |
| 700 | 1 | |a Yang, Yongping |e verfasserin |4 aut | |
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