Reduced liver cancer mortality with regular clinic follow-up among patients with chronic hepatitis B: A nationwide cohort study.
Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular
/ etiology
Cause of Death
Cohort Studies
Female
Follow-Up Studies
Hepatitis B, Chronic
/ complications
Humans
Incidence
Kaplan-Meier Estimate
Liver Neoplasms
/ etiology
Male
Middle Aged
Proportional Hazards Models
Public Health Surveillance
Republic of Korea
/ epidemiology
Socioeconomic Factors
Young Adult
adult liver cancer
chronic hepatitis B
mortality
office visits
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
21
05
2020
revised:
05
08
2020
accepted:
07
08
2020
pubmed:
29
8
2020
medline:
20
5
2021
entrez:
29
8
2020
Statut:
ppublish
Résumé
Regular clinic follow-up is a prerequisite for optimal antiviral therapy and surveillance of hepatocellular carcinoma in patients with chronic hepatitis B (CHB). However, adherence to regular follow-up stays low in practice. This study investigated whether regular follow-up is associated with decreased liver cancer mortality in CHB patients. A nationwide population-based historical cohort study was conducted using customized data from the National Health Insurance Service of Korea. The number of hospital visits every 3-month interval was counted for 2 years from the date of CHB diagnosis. Patients were classified into three follow-up groups: regular (four to eight visits), irregular (one to three visits), and no follow-up. The risk of liver cancer mortality was compared among the groups using Cox proportional hazard regression analysis. Of the 414 074 CHB patients, 22.9% had regular follow-up. In multivariable analysis, regular follow-up was independently associated with decreased risk of liver cancer mortality compared to no follow-up (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.50-0.63, P < .001). Regular follow-up was also associated with the lowest risk of all-cause mortality (HR, 0.60; 95% CI, 0.57-0.63, P < .001). Patients with regular follow-up received more curative treatment (23.1% vs 15.1%, P < .001). Patients were less motivated when they were female, >60 years, of low socioeconomic status, disabled, lived in a rural area, had a higher comorbidity rate, or did not have cirrhosis. Regular follow-up at least every 3-6 months is significantly associated with reduced liver cancer mortality in patients with CHB.
Sections du résumé
BACKGROUND
Regular clinic follow-up is a prerequisite for optimal antiviral therapy and surveillance of hepatocellular carcinoma in patients with chronic hepatitis B (CHB). However, adherence to regular follow-up stays low in practice. This study investigated whether regular follow-up is associated with decreased liver cancer mortality in CHB patients.
METHODS
A nationwide population-based historical cohort study was conducted using customized data from the National Health Insurance Service of Korea. The number of hospital visits every 3-month interval was counted for 2 years from the date of CHB diagnosis. Patients were classified into three follow-up groups: regular (four to eight visits), irregular (one to three visits), and no follow-up. The risk of liver cancer mortality was compared among the groups using Cox proportional hazard regression analysis.
RESULTS
Of the 414 074 CHB patients, 22.9% had regular follow-up. In multivariable analysis, regular follow-up was independently associated with decreased risk of liver cancer mortality compared to no follow-up (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.50-0.63, P < .001). Regular follow-up was also associated with the lowest risk of all-cause mortality (HR, 0.60; 95% CI, 0.57-0.63, P < .001). Patients with regular follow-up received more curative treatment (23.1% vs 15.1%, P < .001). Patients were less motivated when they were female, >60 years, of low socioeconomic status, disabled, lived in a rural area, had a higher comorbidity rate, or did not have cirrhosis.
CONCLUSIONS
Regular follow-up at least every 3-6 months is significantly associated with reduced liver cancer mortality in patients with CHB.
Identifiants
pubmed: 32857923
doi: 10.1002/cam4.3421
pmc: PMC7571840
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
7781-7791Informations de copyright
© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
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