中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 3
Mar.  2023
Turn off MathJax
Article Contents

Association of P-I-R classification and Laennec grading with histology and prognosis after antiviral therapy in patients with hepatitis B cirrhosis

DOI: 10.3969/j.issn.1001-5256.2023.03.015
Research funding:

National Science and Technology Major Projectduring the 13th Five-Year Plan Period (NCT01965418);

Beijing Natural Science Foundation (7212101)

More Information
  • Corresponding author: YANG Yongping, yongpingyang@hotmail.com(ORCID: 0000-0002-8307-1095)
  • Received Date: 2022-12-05
  • Accepted Date: 2023-01-11
  • Published Date: 2023-03-20
  •   Objective  To investigate the role of P-I-R classification and Laennec grading in evaluating histological changes in patients with hepatitis B cirrhosis after receiving antiviral therapy, as well as the association of these two evaluation systems with clinical prognosis.  Methods  A total of 218 patients from 14 centers were consecutively screened from October 2013 to October 2014, and these patients were diagnosed with liver cirrhosis based on pathology (Ishak score ≥5), received antiviral therapy for 72 weeks, completed two liver biopsies, and met the P-I-R classification criteria. The 218 patients were divided into non-hepatocellular carcinoma (HCC) group with 186 patients and HCC group with 32 patients. The chi-square test and the Fisher's exact test were used for comparison of categorical data between groups. For the comparison of HCC after antiviral therapy, the non-parametric Mann-Whitney U test was used for continuous variables, and for the comparison of P-I-R classification and Laennec grading, the non-parametric Kruskal-Wallis H test was used for continuous variables. Univariate and multivariate Cox regression analyses were used to calculate hazard ratio (HR) and 95% confidence interval (CI), and the Kaplan-Meier method was used to calculate the cumulative incidence rate of HCC.  Results  After 72 weeks of antiviral therapy, there was a significant difference in P-I-R classification between the non-HCC group and the HCC group (P < 0.001). There were significant differences in the distribution of Laennec grading and P-I-R classification before and after antiviral therapy (P < 0.001). After antiviral therapy, the 218 patients were divided into 4A group with 33 patients, 4B group with 71 patients, and 4C group with 114 patients according to Laennec grading, and there were significant differences between these three groups in platelet count (PLT) (H=36.429, P < 0.001), liver stiffness measurement (LSM) (H=13.983, P=0.004), Ishak score (χ2=23.060, P < 0.001), and HAI score (P < 0.001). After antiviral therapy, the 218 patients were divided into R group with 70 patients, I group with 52 patients, and P group with 96 patients according to P-I-R classification, and there were significant differences between these three groups in PLT (H=7.193, P=0.028), LSM (H=6.238, P=0.045), Ishak score (χ2=7.986, P < 0.001), HAI score (P=0.002), and HCC (P < 0.001). There was a significant difference in the incidence rate of HCC between the P and R groups based on P-I-R classification (HR=24.21, 95%CI: 0.46-177.99, P=0.002). After adjustment for other confounding factors, P-I-R classification was an independent predictive factor for HCC (HR=12.69, 95%CI: 4.63-34.80, P=0.002).  Conclusion  Both P-I-R classification and Laennec grading can reflect the features and changes of fibrosis before and after antiviral therapy, and P-I-R classification is more sensitive to fibrosis changes after antiviral therapy. P-I-R classification (after treatment) can be used to assess the risk of HCC in patients after antiviral therapy.

     

  • loading
  • [1]
    D'AMICO G, MORABITO A, D'AMICO M, et al. Clinical states of cirrhosis and competing risks[J]. J Hepatol, 2018, 68(3): 563-576. DOI: 10.1016/j.jhep.2017.10.020.
    [2]
    HYTIROGLOU P, THEISE ND. Regression of human cirrhosis: an update, 18 years after the pioneering article by Wanless et al[J]. Virchows Arch, 2018, 473(1): 15-22. DOI: 10.1007/s00428-018-2340-2.
    [3]
    CHANG TT, LIAW YF, WU SS, et al. Long-term entecavir therapy results in the reversal of fibrosis/cirrhosis and continued histological improvement in patients with chronic hepatitis B[J]. Hepatology, 2010, 52(3): 886-893. DOI: 10.1002/hep.23785.
    [4]
    SCHIFF ER, LEE SS, CHAO YC, et al. Long-term treatment with entecavir induces reversal of advanced fibrosis or cirrhosis in patients with chronic hepatitis B[J]. Clin Gastroenterol Hepatol, 2011, 9(3): 274-276. DOI: 10.1016/j.cgh.2010.11.040.
    [5]
    RAMACHANDRAN P, IREDALE JP, FALLOWFIELD JA. Resolution of liver fibrosis: basic mechanisms and clinical relevance[J]. Semin Liver Dis, 2015, 35(2): 119-131. DOI: 10.1055/s-0035-1550057.
    [6]
    SINGAL AG, LIM JK, KANWAL F. AGA clinical practice update on interaction between oral direct-acting antivirals for chronic hepatitis C infection and hepatocellular carcinoma: Expert review[J]. Gastroenterology, 2019, 156(8): 2149-2157. DOI: 10.1053/j.gastro.2019.02.046.
    [7]
    ROCKEY DC, CALDWELL SH, GOODMAN ZD, et al. Liver biopsy[J]. Hepatology, 2009, 49(3): 1017-1044. DOI: 10.1002/hep.22742.
    [8]
    KNODELL RG, ISHAK KG, BLACK WC, et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis[J]. Hepatology, 1981, 1(5): 431-435. DOI: 10.1002/hep.1840010511.
    [9]
    BATTS KP. Acute and chronic hepatic allograft rejection: pathology and classification[J]. Liver Transpl Surg, 1999, 5(4 Suppl 1): S21-S29. DOI: 10.1053/JTLS005s00021.
    [10]
    SCHEUER PJ. Classification of chronic viral hepatitis: a need for reassessment[J]. J Hepatol, 1991, 13(3): 372-374. DOI: 10.1016/0168-8278(91)90084-o.
    [11]
    LUDWIG J. The nomenclature of chronic active hepatitis: an obituary[J]. Gastroenterology, 1993, 105(1): 274-278. DOI: 10.1016/0016-5085(93)90037-d.
    [12]
    WANG W, LI J, PAN R, et al. Association of the Laennec staging system with degree of cirrhosis, clinical stage and liver function[J]. Hepatol Int, 2015, 9(4): 621-626. DOI: 10.1007/s12072-015-9648-7.
    [13]
    KIM MY, CHO MY, BAIK SK, et al. Histological subclassification of cirrhosis using the Laennec fibrosis scoring system correlates with clinical stage and grade of portal hypertension[J]. J Hepatol, 2011, 55(5): 1004-1009. DOI: 10.1016/j.jhep.2011.02.012.
    [14]
    KIM SU, OH HJ, WANLESS IR, et al. The Laennec staging system for histological sub-classification of cirrhosis is useful for stratification of prognosis in patients with liver cirrhosis[J]. J Hepatol, 2012, 57(3): 556-563. DOI: 10.1016/j.jhep.2012.04.029.
    [15]
    SUN Y, ZHOU J, WANG L, et al. New classification of liver biopsy assessment for fibrosis in chronic hepatitis B patients before and after treatment[J]. Hepatology, 2017, 65(5): 1438-1450. DOI: 10.1002/hep.29009.
    [16]
    RONG G, CHEN Y, YU Z, et al. Synergistic effect of biejia-ruangan on fibrosis regression in patients with chronic hepatitis B treated with entecavir: A multicenter, randomized, double-blind, placebo-controlled trial[J]. J Infect Dis, 2022, 225(6): 1091-1099. DOI: 10.1093/infdis/jiaa266.
    [17]
    JI D, CHEN Y, BI J, et al. Entecavir plus Biejia-Ruangan compound reduces the risk of hepatocellular carcinoma in Chinese patients with chronic hepatitis B[J]. J Hepatol, 2022, 77(6): 1515-1524. DOI: 10.1016/j.jhep.2022.07.018.
    [18]
    FATTOVICH G, STROFFOLINI T, ZAGNI I, et al. Hepatocellular carcinoma in cirrhosis: incidence and risk factors[J]. Gastroenterology, 2004, 127(5 Suppl 1): S35-S50. DOI: 10.1053/j.gastro.2004.09.014.
    [19]
    NAGULA S, JAIN D, GROSZMANN RJ, et al. Histological-hemodynamic correlation in cirrhosis-a histological classification of the severity of cirrhosis[J]. J Hepatol, 2006, 44(1): 111-117. DOI: 10.1016/j.jhep.2005.07.036.
    [20]
    SETHASINE S, JAIN D, GROSZMANN RJ, et al. Quantitative histological-hemodynamic correlations in cirrhosis[J]. Hepatology, 2012, 55(4): 1146-1153. DOI: 10.1002/hep.24805.
    [21]
    ZIPPRICH A, GARCIA-TSAO G, ROGOWSKI S, et al. Prognostic indicators of survival in patients with compensated and decompensated cirrhosis[J]. Liver Int, 2012, 32(9): 1407-1414. DOI: 10.1111/j.1478-3231.2012.02830.x.
    [22]
    RIPOLL C, BAÑARES R, RINCÓN D, et al. Influence of hepatic venous pressure gradient on the prediction of survival of patients with cirrhosis in the MELD Era[J]. Hepatology, 2005, 42(4): 793-801. DOI: 10.1002/hep.20871.
    [23]
    JAIN D, SREENIVASAN P, INAYAT I, et al. Thick fibrous septa on liver biopsy specimens predict the development of decompensation in patients with compensated cirrhosis[J]. Am J Clin Pathol, 2021, 156(5): 802-809. DOI: 10.1093/ajcp/aqab024.
    [24]
    WANLESS IR, NAKASHIMA E, SHERMAN M. Regression of human cirrhosis. Morphologic features and the genesis of incomplete septal cirrhosis[J]. Arch Pathol Lab Med, 2000, 124(11): 1599-1607. DOI: 10.5858/2000-124-1599-ROHC.
    [25]
    HE ZY, WANG BQ, YOU H. Clinical application of quantitative assessment of liver fibrosis based on pathology and imaging technology[J]. J Clin Hepatol, 2018, 35(1): 20-23. DOI: 10.3969/j.issn.1001-5256.2018.01.003.

    何志颖, 王冰琼, 尤红. 基于病理和影像学的肝纤维化量化评估技术的临床应用[J]. 临床肝胆病杂志, 2018, 34(1): 20-23. DOI: 10.3969/j.issn.1001-5256.2018.01.003.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(4)  / Tables(5)

    Article Metrics

    Article views (297) PDF downloads(69) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return