Cancer Epidemiol Biomarkers Prev. 2020 Jan 27. pii: cebp.0614.2019. doi: 10.1158/1055-9965.EPI-19-0614. [Epub ahead of print]
Hepatocellular carcinoma risk steadily persists over time despite long-term antiviral therapy for hepatitis B: A multicenter study.
Kim SU1, Seo YS2, Lee HA2, Kim MN3, Lee EJ1, Shin HJ1, Lee YR4, Lee HW1, Park JY1, Kim DY1, Ahn SH1, Han KH1, Um SH5, Tak WY6, Kweon YO6, Kim BK7, Park SY6.
Author information
1
Department of Internal Medicine, Yonsei University College of Medicine.
2
Internal medicine, Korea University College of Medicine.
3
CHA Bundang Medical Center.
4
Kyungpook National University.
5
Korea University College of Medicine.
6
Department of Internal Medicine, Kyungpook National University.
7
Department of Internal Medicine, Yonsei University College of Medicine [email protected].
Abstract
BACKGROUND:
Long-term antiviral therapy (AVT) for chronic hepatitis B (CHB) reduces the risk of hepatocellular carcinoma (HCC). We assessed the temporal trends in the incidence of HCC over time during long-term AVT among Asian CHB patients.
METHODS:
Patients with CHB receiving entecavir/tenofovir (ETV/TDF) as a first line antiviral were recruited from four academic hospitals in the Republic of Korea. We compared the incidence of HCC during and after the first 5 years of ETV/TDF treatment.
RESULTS:
Among 3,156 patients, the median age was 49.6 years and males predominated (62.4%). During the follow-up, 9.0% developed HCC. The annual incidence of HCC per 100 person-years during the first 5 years (n = 1,671) and after the first 5 years (n = 1,485) was statistically similar (1.93% vs. 2.27%, p = 0.347). When the study population was stratified according to HCC prediction model; i.e., modified PAGE-B score, the annual incidence of HCC was 0.11% vs. 0.39% in the low-risk group (<8 points), 1.26% vs. 1.82% in the intermediate-risk group (9-12 points), and 4.63% vs. 5.24% in the high-risk group (≥13 points) (all p>0.05). A Poisson regression analysis indicated that the duration of AVT did not significantly affect the overall trend of the incidence of HCC (adjusted annual incidence rate ratio 0.85 [95% confidence interval 0.66-1.11; p = 0.232]).
CONCLUSIONS:
Despite long-term AVT, the risk of HCC steadily persists over time among CHB patients in the Republic of Korea, in whom HBV genotype C2 predominates.
IMPACT:
Therefore, careful HCC surveillance is still essential.