Carcinoma hepatocelular em portadores crônicos do vírus da hepatite B: incidência, fatores de risco e acurácia de escores preditores
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UFMA |
Texto Completo: | https://tedebc.ufma.br/jspui/handle/tede/tede/4531 |
Resumo: | Chronic hepatitis virus (HBV) infection is one of the main risk factors for hepatocellular carcinoma (HCC). The incidence of HCC in HBV carriers, as well as its occurrence in the absence of liver cirrhosis, remains uncertain in Brazil. This study aimed to evaluate the effectiveness of HCC screening in HBV carriers, in a specialized service, in order to identify high-risk patients. Methods: This was a retrospective cohort study involving 1,040 chronic HBV carriers, followed in a single service in a state in northeastern Brazil. The HCC incidence density was calculated considering the new cases that occurred during the study period. Kaplan-Meier analysis was used to estimate the cumulative incidence of HCC. For the analysis of predictors of HCC development, the Cox regression technique was used. Results: Among the 1,040 patients, 53.7% were women and the median age was 48 years. The median follow-up time was 52 months. The median interval between visits was 6.55 months, and in 75% of the sample the interval was up to 8 months and regular follow-up was carried out for at least 96 months. Thirty cases of HCC (2.9%) were identified during follow-up. All cases occurred in cirrhotic patients. The HCC incidence rate for the entire population was 5.3 per 1000 person-years of observation. Only age and positive HBeAg were independently associated with an increased risk of developing HCC. Conclusion: The presence of cirrhosis in all patients who developed HCC in a sample of HBV carriers from a single Brazilian center where surveillance was effective in 75% of the sample, it is a very relevant fact, reinforcing the importance of strict and periodic surveillance in cirrhotic patients. |
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FERREIRA, Adalgisa de Souza Paivahttp://lattes.cnpq.br/6707376027989566FERREIRA, Adalgisa de Souza Paivahttp://lattes.cnpq.br/6707376027989566FERRAZ, Maria Lúcia Cardoso Gomeshttp://lattes.cnpq.br/1870810357457710PEREZ, Renata de Mellohttp://lattes.cnpq.br/0870986021644250TORRES, Orlando Jorge Martinshttp://lattes.cnpq.br/6448439573128558AZEVEDO, Conceição de Maria Pedrozo e Silva dehttp://lattes.cnpq.br/1702212486285798http://lattes.cnpq.br/4550331089462501COSTA, Alessandra Porto de Macedo2023-02-08T13:37:46Z2023-01-12COSTA, Alessandra Porto de Macedo. Carcinoma hepatocelular em portadores crônicos do vírus da hepatite B: incidência, fatores de risco e acurácia de escores preditores. 2023. 88 f. Tese (Programa de Pós-Graduação em Ciências da Saúde/CCBS) - Universidade Federal do Maranhão, São Luís, 2023.https://tedebc.ufma.br/jspui/handle/tede/tede/4531Chronic hepatitis virus (HBV) infection is one of the main risk factors for hepatocellular carcinoma (HCC). The incidence of HCC in HBV carriers, as well as its occurrence in the absence of liver cirrhosis, remains uncertain in Brazil. This study aimed to evaluate the effectiveness of HCC screening in HBV carriers, in a specialized service, in order to identify high-risk patients. Methods: This was a retrospective cohort study involving 1,040 chronic HBV carriers, followed in a single service in a state in northeastern Brazil. The HCC incidence density was calculated considering the new cases that occurred during the study period. Kaplan-Meier analysis was used to estimate the cumulative incidence of HCC. For the analysis of predictors of HCC development, the Cox regression technique was used. Results: Among the 1,040 patients, 53.7% were women and the median age was 48 years. The median follow-up time was 52 months. The median interval between visits was 6.55 months, and in 75% of the sample the interval was up to 8 months and regular follow-up was carried out for at least 96 months. Thirty cases of HCC (2.9%) were identified during follow-up. All cases occurred in cirrhotic patients. The HCC incidence rate for the entire population was 5.3 per 1000 person-years of observation. Only age and positive HBeAg were independently associated with an increased risk of developing HCC. Conclusion: The presence of cirrhosis in all patients who developed HCC in a sample of HBV carriers from a single Brazilian center where surveillance was effective in 75% of the sample, it is a very relevant fact, reinforcing the importance of strict and periodic surveillance in cirrhotic patients.Introdução e objetivo: A infecção crônica pelo vírus da hepatite (VHB) é um dos principais fatores de risco para o carcinoma hepatocelular (CHC). A incidência do CHC em portadores de VHB, assim como sua ocorrência na ausência de cirrose hepática, permanece incerta no Brasil. Este estudo teve como objetivo avaliar a efetividade do rastreamento do CHC em portadores do VHB, em um serviço especializado, visando identificar pacientes de alto risco. Materiais e métodos: Este foi um estudo de coorte retrospectivo envolvendo 1.040 portadores crônicos do VHB, acompanhados em um único serviço de um estado do nordeste do Brasil. A densidade da incidência do CHC foi calculada considerando os novos casos que ocorreram durante o período do estudo. A análise de Kaplan-Meier foi usada para estimar a incidência cumulativa de CHC. Para a análise dos fatores preditores de desenvolvimento de CHC a técnica de regressão de Cox foi utilizada. Resultados: Entre os 1.040 pacientes, 53,7% eram mulheres e a mediana da idade foi de 48 anos. A mediana do tempo de acompanhamento foi de 52 meses. A mediana do intervalo entre as consultas foi de 6,55 meses, sendo que em 75% da amostra o intervalo foi de até 8 meses e o acompanhamento regular foi feito por no mínimo 96 meses. Foram identificados 30 casos de CHC (2,9%) durante o acompanhamento. Todos os casos ocorreram em cirróticos. A taxa de incidência de CHC para toda a população foi de 5,3 por 1000 pessoas/ano de observação. Apenas a idade e o HBeAg positivo estiveram independentemente associados a um risco aumentado de desenvolvimento de CHC. Conclusão: A presença de cirrose em todos os pacientes que desenvolveram CHC em uma amostra de portadores do VHB de um único centro brasileiro, em que a vigilância foi efetiva em 75% da amostra, é um dado bastante relevante, reforçando a importância da vigilância rigorosa e periódica nos pacientes cirróticos.Submitted by Jonathan Sousa de Almeida (jonathan.sousa@ufma.br) on 2023-02-08T13:37:46Z No. of bitstreams: 1 ALESSANDRAPORTODEMACEDOCOSTA.pdf: 2409639 bytes, checksum: db293eebd14a93994431a99eb4b42f51 (MD5)Made available in DSpace on 2023-02-08T13:37:46Z (GMT). No. of bitstreams: 1 ALESSANDRAPORTODEMACEDOCOSTA.pdf: 2409639 bytes, checksum: db293eebd14a93994431a99eb4b42f51 (MD5) Previous issue date: 2023-01-12application/pdfporUniversidade Federal do MaranhãoPROGRAMA DE PÓS-GRADUAÇÃO EM CIÊNCIAS DA SAÚDE/CCBSUFMABrasilDEPARTAMENTO DE MEDICINA I/CCBSHepatite B crônica,cirrose hepática;carcinoma hepatocelular;incidência;vigilância;fatores de risco.Chronic hepatitis B;liver cirrhosis;hepatocellular carcinoma;incidence;surveillance;risk factors.Doenças InfecciosasCiências da SaúdeCarcinoma hepatocelular em portadores crônicos do vírus da hepatite B: incidência, fatores de risco e acurácia de escores preditoresHepatocellular carcinoma in chronic carriers of hepatitis B virus: incidence, risk factors, and accuracy of predictor scoresinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UFMAinstname:Universidade Federal do Maranhão (UFMA)instacron:UFMAORIGINALALESSANDRAPORTODEMACEDOCOSTA.pdfALESSANDRAPORTODEMACEDOCOSTA.pdfapplication/pdf2409639http://tedebc.ufma.br:8080/bitstream/tede/4531/2/ALESSANDRAPORTODEMACEDOCOSTA.pdfdb293eebd14a93994431a99eb4b42f51MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82255http://tedebc.ufma.br:8080/bitstream/tede/4531/1/license.txt97eeade1fce43278e63fe063657f8083MD51tede/45312023-05-22 14:27:32.326oai:tede2: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Biblioteca Digital de Teses e Dissertaçõeshttps://tedebc.ufma.br/jspui/PUBhttp://tedebc.ufma.br:8080/oai/requestrepositorio@ufma.br||repositorio@ufma.bropendoar:21312023-05-22T17:27:32Biblioteca Digital de Teses e Dissertações da UFMA - Universidade Federal do Maranhão (UFMA)false |
dc.title.por.fl_str_mv |
Carcinoma hepatocelular em portadores crônicos do vírus da hepatite B: incidência, fatores de risco e acurácia de escores preditores |
dc.title.alternative.eng.fl_str_mv |
Hepatocellular carcinoma in chronic carriers of hepatitis B virus: incidence, risk factors, and accuracy of predictor scores |
title |
Carcinoma hepatocelular em portadores crônicos do vírus da hepatite B: incidência, fatores de risco e acurácia de escores preditores |
spellingShingle |
Carcinoma hepatocelular em portadores crônicos do vírus da hepatite B: incidência, fatores de risco e acurácia de escores preditores COSTA, Alessandra Porto de Macedo Hepatite B crônica, cirrose hepática; carcinoma hepatocelular; incidência; vigilância; fatores de risco. Chronic hepatitis B; liver cirrhosis; hepatocellular carcinoma; incidence; surveillance; risk factors. Doenças Infecciosas Ciências da Saúde |
title_short |
Carcinoma hepatocelular em portadores crônicos do vírus da hepatite B: incidência, fatores de risco e acurácia de escores preditores |
title_full |
Carcinoma hepatocelular em portadores crônicos do vírus da hepatite B: incidência, fatores de risco e acurácia de escores preditores |
title_fullStr |
Carcinoma hepatocelular em portadores crônicos do vírus da hepatite B: incidência, fatores de risco e acurácia de escores preditores |
title_full_unstemmed |
Carcinoma hepatocelular em portadores crônicos do vírus da hepatite B: incidência, fatores de risco e acurácia de escores preditores |
title_sort |
Carcinoma hepatocelular em portadores crônicos do vírus da hepatite B: incidência, fatores de risco e acurácia de escores preditores |
author |
COSTA, Alessandra Porto de Macedo |
author_facet |
COSTA, Alessandra Porto de Macedo |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
FERREIRA, Adalgisa de Souza Paiva |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/6707376027989566 |
dc.contributor.referee1.fl_str_mv |
FERREIRA, Adalgisa de Souza Paiva |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/6707376027989566 |
dc.contributor.referee2.fl_str_mv |
FERRAZ, Maria Lúcia Cardoso Gomes |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/1870810357457710 |
dc.contributor.referee3.fl_str_mv |
PEREZ, Renata de Mello |
dc.contributor.referee3Lattes.fl_str_mv |
http://lattes.cnpq.br/0870986021644250 |
dc.contributor.referee4.fl_str_mv |
TORRES, Orlando Jorge Martins |
dc.contributor.referee4Lattes.fl_str_mv |
http://lattes.cnpq.br/6448439573128558 |
dc.contributor.referee5.fl_str_mv |
AZEVEDO, Conceição de Maria Pedrozo e Silva de |
dc.contributor.referee5Lattes.fl_str_mv |
http://lattes.cnpq.br/1702212486285798 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/4550331089462501 |
dc.contributor.author.fl_str_mv |
COSTA, Alessandra Porto de Macedo |
contributor_str_mv |
FERREIRA, Adalgisa de Souza Paiva FERREIRA, Adalgisa de Souza Paiva FERRAZ, Maria Lúcia Cardoso Gomes PEREZ, Renata de Mello TORRES, Orlando Jorge Martins AZEVEDO, Conceição de Maria Pedrozo e Silva de |
dc.subject.por.fl_str_mv |
Hepatite B crônica, cirrose hepática; carcinoma hepatocelular; incidência; vigilância; fatores de risco. |
topic |
Hepatite B crônica, cirrose hepática; carcinoma hepatocelular; incidência; vigilância; fatores de risco. Chronic hepatitis B; liver cirrhosis; hepatocellular carcinoma; incidence; surveillance; risk factors. Doenças Infecciosas Ciências da Saúde |
dc.subject.eng.fl_str_mv |
Chronic hepatitis B; liver cirrhosis; hepatocellular carcinoma; incidence; surveillance; risk factors. |
dc.subject.cnpq.fl_str_mv |
Doenças Infecciosas Ciências da Saúde |
description |
Chronic hepatitis virus (HBV) infection is one of the main risk factors for hepatocellular carcinoma (HCC). The incidence of HCC in HBV carriers, as well as its occurrence in the absence of liver cirrhosis, remains uncertain in Brazil. This study aimed to evaluate the effectiveness of HCC screening in HBV carriers, in a specialized service, in order to identify high-risk patients. Methods: This was a retrospective cohort study involving 1,040 chronic HBV carriers, followed in a single service in a state in northeastern Brazil. The HCC incidence density was calculated considering the new cases that occurred during the study period. Kaplan-Meier analysis was used to estimate the cumulative incidence of HCC. For the analysis of predictors of HCC development, the Cox regression technique was used. Results: Among the 1,040 patients, 53.7% were women and the median age was 48 years. The median follow-up time was 52 months. The median interval between visits was 6.55 months, and in 75% of the sample the interval was up to 8 months and regular follow-up was carried out for at least 96 months. Thirty cases of HCC (2.9%) were identified during follow-up. All cases occurred in cirrhotic patients. The HCC incidence rate for the entire population was 5.3 per 1000 person-years of observation. Only age and positive HBeAg were independently associated with an increased risk of developing HCC. Conclusion: The presence of cirrhosis in all patients who developed HCC in a sample of HBV carriers from a single Brazilian center where surveillance was effective in 75% of the sample, it is a very relevant fact, reinforcing the importance of strict and periodic surveillance in cirrhotic patients. |
publishDate |
2023 |
dc.date.accessioned.fl_str_mv |
2023-02-08T13:37:46Z |
dc.date.issued.fl_str_mv |
2023-01-12 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
COSTA, Alessandra Porto de Macedo. Carcinoma hepatocelular em portadores crônicos do vírus da hepatite B: incidência, fatores de risco e acurácia de escores preditores. 2023. 88 f. Tese (Programa de Pós-Graduação em Ciências da Saúde/CCBS) - Universidade Federal do Maranhão, São Luís, 2023. |
dc.identifier.uri.fl_str_mv |
https://tedebc.ufma.br/jspui/handle/tede/tede/4531 |
identifier_str_mv |
COSTA, Alessandra Porto de Macedo. Carcinoma hepatocelular em portadores crônicos do vírus da hepatite B: incidência, fatores de risco e acurácia de escores preditores. 2023. 88 f. Tese (Programa de Pós-Graduação em Ciências da Saúde/CCBS) - Universidade Federal do Maranhão, São Luís, 2023. |
url |
https://tedebc.ufma.br/jspui/handle/tede/tede/4531 |
dc.language.iso.fl_str_mv |
por |
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por |
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info:eu-repo/semantics/openAccess |
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openAccess |
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dc.publisher.none.fl_str_mv |
Universidade Federal do Maranhão |
dc.publisher.program.fl_str_mv |
PROGRAMA DE PÓS-GRADUAÇÃO EM CIÊNCIAS DA SAÚDE/CCBS |
dc.publisher.initials.fl_str_mv |
UFMA |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
DEPARTAMENTO DE MEDICINA I/CCBS |
publisher.none.fl_str_mv |
Universidade Federal do Maranhão |
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