Impact of age and gender on risk of hepatocellular carcinoma after hepatitis B surface antigen seroclearance
Article · June 2017
DOI: 10.1016/j.jhep.2017.06.019
Terry Cheuk-Fung Yip
17.46 · The Chinese University of Hong Kong
Henry LY Chan
51.08 · The Chinese University of Hong Kong
Vincent Wai-Sun Wong
49.62 · The Chinese University of Hong Kong
Grace Wong
University of Hong Kong
Abstract
Background and Aims Previous studies suggested spontaneous seroclearance of hepatitis B surface antigen (HBsAg) after 50 years old was still associated with an increased risk of hepatocellular carcinoma (HCC). This study aimed to evaluate the risk of HCC after HBsAg seroclearance and the impact of gender on HCC. Methods All chronic hepatitis B patients under medical care in Hospital Authority, Hong Kong who have cleared HBsAg from January 2000 to August 2016 were identified. The age of HBsAg seroclearance, gender, and subsequent development of HCC were captured and analyzed. Results 4,568 patients with HBsAg seroclearance were identified; 793 (17.4%) were treated by nucleos(t)ide analogues and 60 (1.3%) had received interferon treatment. At a median (interquartile range) follow-up of 3.4 (1.5–5.0) years, 54 patients developed HCC; cumulative incidence of HCC at 1, 3 and 5 years were 0.9%, 1.3% and 1.5%, respectively. Age above 50 years (adjusted hazard ratio 4.31, 95% confidence interval 1.72 – 10.84; P=0.002) and male gender (2.47, 1.24 – 4.91; P=0.01) were two independent risk factors of HCC. Female patients aged ≤50 years (n=545) had zero risk of HCC in 5 years. Male patients aged ≤50 years (n=769), female patients aged >50 years (n=1,149) and male patients aged >50 years (n=2,105) had a 5-year cumulative incidence of HCC 0.7%, 1.0% and 2.5%, respectively. Similar findings were observed in patients with spontaneous and antiviral treatment-induced HBsAg seroclearance. Conclusions Female patients aged 50 years or below have zero risk of HCC after HBsAg seroclearance, whereas female patients aged above 50 years and all male patients are still at risk of HCC.
