Incidence of hepatocellular carcinoma after HBsAg seroclearance in chronic hepatitis B patients: A need for surveillance
Gi-Ae Kim,Han Chu Lee correspondence email,
Min-Ju Kim,Yeonjung Ha,Eui Ju Park,Jihyun An,Danbi Lee,Ju yun Shim,Kang Mo Kim,Young-Suk Lim
Received: August 27, 2014; Received in revised form: November 19, 2014; Accepted: November 20, 2014; Published Online: November 28, 2014
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DOI: http://dx.doi.org/10.1016/j.jhep.2014.11.031
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Background & Aims
Little is known about whether surveillance for hepatocellular carcinoma (HCC) is worthwhile in chronic hepatitis B virus (HBV)-infected patients who have achieved HBsAg seroclearance.
Methods
A retrospective analysis of 829 patients (mean age: 52.3 years; 575 males; 98 with cirrhosis) achieving HBsAg seroclearance was performed at a tertiary hospital in Korea between 1997 and 2012. We evaluated incidence rates of HCC, and validated CU-HCC score based on data at the time of HBsAg seroclearance.
Results
During a follow-up of 3464 patient-years, 19 patients developed HCC (annual rate: 0.55%). Liver cirrhosis (hazard ratio [HR]: 10.80; 95% confidence interval [CI]: 4.25–27.43), male gender (HR: 8.96; 95% CI: 1.17–68.80), and age ⩾50 years at the time of HBsAg seroclearance (HR: 12.14; 95% CI: 1.61–91.68) were independently associated with HCC. The estimated annual incidence of HCC was 2.85% and 0.29% in patients with and without cirrhosis, respectively. Among the non-cirrhotic patients, the annual rate of HCC was higher in the male patients than in the females (0.40% vs. 0%, respectively), and all the HCCs developed after age 50. The time-dependent area under the receiver operating characteristic curves for the CU-HCC score for 5 year and 10 year HCC prediction were 0.85 and 0.74, respectively.
Conclusions
HCC surveillance should be considered for cirrhotic patients and non-cirrhotic male patients over age 50, even after HBsAg seroclearance, especially those infected with HBV genotype C. HBsAg seroclearance at age ⩾50 years was also an independent predictor for HCC.
Abbreviations:
AFP (alpha-fetoprotein), ALT (alanine aminotransferase), AUC (area under the receiver operating characteristic curve), BCLC (Barcelona Clinic Liver Cancer), CHB (chronic hepatitis B), CI (confidence interval), GGT (gamma-glutamyl transferase), HBeAg (hepatitis B e antigen), HBsAg (hepatitis B surface antigen), HBV (hepatitis B virus), HCC (hepatocellular carcinoma), HR (hazard ratio), INR (international normalized ratio), IQR (interquartile range), NUC (nucleoside analogue), ROC (receiver operating characteristics), SD (standard deviation) 作者: StephenW 时间: 2015-4-16 06:12