J Viral Hepat. 2017 Nov 28. doi: 10.1111/jvh.12832. [Epub ahead of print]
Temporal Trend and Risk Determinants of Hepatocellular Carcinoma in Chronic Hepatitis B Patients on Entecavir or Tenofovir.Hsu YC1, Ho HJ2, Lee TY2,3, Huang YT4,5, Wu MS6, Lin JT1,7, Wu CY8,2,9, El-Serag HB10. Author information 1School of Medicine and Big Data Research Center, Fu-Jen Catholic University, 2Department of Internal Medicine, Fu-Jen Catholic University Hospital New Taipei, Taiwan.2Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan.3Department of Medicine, Chung Shan Medical University, Taichung, Taiwan.4Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.5Departments of Epidemiology and Biostatistics, Brown University, RI, USA.6Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.7Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.8Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan.9School of Medicine, National Yang-Ming University, Taipei, Taiwan.10Section of Gastroenterology and Hepatology, Department of Medicine, Michael E DeBakey VA Medical Center, Baylor College of Medicine, Houston Texas, USA.
AbstractThis study aimed to elucidate the temporal change and determinants for the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B continuously receiving nucleos(t)ide analogues. Through analysis of the national healthcare database in Taiwan, we screened a total of 65,426 infected patients receiving entecavir or tenofovir for at least 3 months and excluded those with lamivudine, adefovir or telbivudine exposure, malignancy, end-stage renal failure, or a diagnosis of HCC within 3 months of starting treatment. Eligible patients (N=27,820) were followed until HCC occurrence, completion of the allowed 3-year regimen, or December 31, 2013. During a median follow-up of 25.1 (12.1-35.6) months, 802 patients developed HCC, with 1-, 2-, and 3-year cumulative incidence of 1.82% (95% CI, 1.66-1.99%), 3.05% (95% CI, 2.82-3.28%), and 4.06% (95% CI, 3.77-4.36%), respectively. HCC annual incidence decreased with an adjusted incidence rate ratio (IRR) of 0.73 (95% CI, 0.66-0.80) per yearly interval, and was associated with cirrhosis (IRR, 10.07; 95% CI, 6.00-16.90 in age <40 years; 4.69; 95% CI, 3.94-5.59 in age ≧40 years), age (IRR, 3.38; 95% CI, 2.10-5.47 for 40-50 years; 6.92; 95% CI, 4.27-11.21 for 50-60 years; 12.50; 95% CI, 7.71-20.25 for ≧60 years; <40 years as reference), male sex (IRR, 1.71; 95% CI, 1.44-2.04), HCV coinfection (IRR, 1.27; 95% CI, 1.02-1.58), and diabetes (IRR, 1.24; 95% CI, 1.05-1.45). In conclusion, the risk of HCC in patients with chronic hepatiti B receiving entecavir or tenofovir declines over time and is determined by cirrhosis, age, male sex, HCV coinfection, and diabetes. This article is protected by copyright. All rights reserved.