Chronic hepatitis B virus (HBV) infection is the predominant cause of hepatocellular carcinoma in west Africa, yet data on the incidence of HBV-related hepatocellular carcinoma remain scarce. We aimed to describe the uptake and early outcomes of systematic ultrasound-based hepatocellular carcinoma screening in SEN-B, which is a prospective HBV cohort in Senegal. In this prospective cohort study, we included treatment-naive, HBsAg-positive individuals who were referred to the two infectious diseases clinics (the Department of Tropical and Infectious Diseases and Ambulatory Treatment Center) at Fann University Hospital of Dakar, Senegal, between Oct 1, 2019, and Oct 31, 2022. All participants resided within the Dakar region. Participants underwent abdominal ultrasound, transient elastography, and clinical and virological assessments at inclusion and every 6 months. Liver lesions at least 1 cm in diameter on ultrasound were assessed using four-phase CT, MRI, or liver biopsy. Adherence to hepatocellular carcinoma surveillance was measured using the proportion of time covered, calculated by dividing the cumulative months covered by abdominal ultrasound examinations by the overall follow-up time, defined as the number of months from the date of cohort entry until the last recorded visit, hepatocellular carcinoma diagnosis, or death. Optimal adherence was defined as a proportion of time covered of 100%. Overall, 755 (99·6%) of 758 participants had at least one abdominal ultrasound performed. The median age of the enrolled participants was 31 years (IQR 25–39), 355 (47·0%) of 755 participants were women, and 82 (10·9%) had a family history of hepatocellular carcinoma. 15 (2·0%) of 755 individuals were HBeAg positive, 206 (27·3%) of 755 individuals had HBV DNA of more than 2000 IU/mL, and 27 (3·6%) of 755 had elastography-defined liver cirrhosis. Of ten (1·3%) participants with a focal lesion at least 1 cm at initial assessment, CT or MRI ruled out hepatocellular carcinoma in nine, whereas imaging and subsequent liver biopsy confirmed one patient with hepatocellular carcinoma. Two further patients with hepatocellular carcinoma were diagnosed at study presentation due to the presence of portal thrombosis on ultrasound. Excluding the three participants with hepatocellular carcinoma identified at baseline, 752 participants were eligible for screening every 6 months. Median follow-up time was 12 months (IQR 6–18) and the median number of ultrasounds per patient was 3 (2–4). During 809·5 person-years of follow-up, one incident hepatocellular carcinoma was reported, resulting in an incidence rate of 1·24 cases per 1000 person-years (95% CI 0·18–8·80). Overall, 702 (93·0%) of 755 participants showed optimal hepatocellular carcinoma surveillance, but this proportion decreased to 77·8% (42 of 54 participants) after 24 months. Hepatocellular carcinoma screening is feasible in HBV research cohorts in west Africa, but its longer-term acceptability needs to be evaluated. Long-term hepatocellular carcinoma incidence data are crucial for shaping tailored screening recommendations. Swiss National Science Foundation, the Swiss Cancer Research Foundation, the National Cancer Institute, and Roche Diagnostics. For the French translation of the abstract see Supplementary Materials section.

中文翻译：

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塞内加尔乙型肝炎患者 (SEN-B) 的肝细胞癌监测：前瞻性队列研究的见解

慢性乙型肝炎病毒（HBV）感染是西非肝细胞癌的主要原因，但有关 HBV 相关肝细胞癌发病率的数据仍然很少。我们的目的是描述 SEN-B（塞内加尔的一个前瞻性 HBV 队列）中基于超声的系统性肝细胞癌筛查的采用情况和早期结果。在这项前瞻性队列研究中，我们纳入了 10 月 1 日期间转诊至塞内加尔达喀尔范恩大学医院的两个传染病诊所（热带传染病科和门诊治疗中心）的未接受治疗的 HBsAg 阳性个体。 ，2019年和2022年10月31日。所有参与者都居住在达喀尔地区。参与者在纳入时和每 6 个月接受一次腹部超声、瞬时弹性成像以及临床和病毒学评估。使用四期 CT、MRI 或肝活检评估超声检查中直径至少 1 厘米的肝脏病变。使用覆盖时间比例来衡量对肝细胞癌监测的依从性，该时间比例是通过将腹部超声检查覆盖的累积月数除以总体随访时间来计算的，总体随访时间定义为从队列进入日期到最后一次记录就诊的月数，肝细胞癌诊断，或死亡。最佳依从性定义为覆盖时间比例为 100%。总体而言，758 名参与者中的 755 名 (99·6%) 至少进行了一次腹部超声检查。入组参与者的中位年龄为 31 岁（IQR 25-39），755 名参与者中 355 名（47·0%）为女性，82 名（10·9%）有肝细胞癌家族史。 755 人中有 15 人 (2·0%) HBeAg 阳性，7​​55 人中 206 人 (27·3%) HBV DNA 超过 2000 IU/mL，755 人中 27 人 (3·6%) 具有弹性成像定义的肝脏肝硬化。在最初评估时局灶性病变至少 1 cm 的 10 名参与者 (1·3%) 中，CT 或 MRI 排除了 9 名患者的肝细胞癌，而影像学和随后的肝活检证实了 1 名患者患有肝细胞癌。另外两名肝细胞癌患者在研究报告时因超声显示门静脉血栓形成而被诊断出。排除基线时发现的三名患有肝细胞癌的参与者，有 752 名参与者有资格每 6 个月接受一次筛查。中位随访时间为 12 个月 (IQR 6-18)，每位患者接受的超声检查中位次数为 3 次 (2-4)。在809·5人年的随访中，报告了1例肝细胞癌，导致发病率为每1000人年1·24例（95% CI 0·18–8·80）。总体而言，755 名参与者中的 702 名 (93·0%) 显示出最佳的肝细胞癌监测，但 24 个月后这一比例下降至 77·8%（54 名参与者中的 42 名）。肝细胞癌筛查在西非的 HBV 研究队列中是可行的，但其长期可接受性需要评估。长期肝细胞癌发病率数据对于制定量身定制的筛查建议至关重要。瑞士国家科学基金会、瑞士癌症研究基金会、国家癌症研究所和罗氏诊断公司。有关摘要的法文翻译，请参阅补充材料部分。