结论：我们的研究结果表明，非肝硬化 CHBe 患者停止有效的长期 NA 治疗与 HCC 风险增加无关，后者不受 NA 后复发和/或 HBsAg 消失的影响。
关键词：停产；恩替卡韦；肝癌;核苷类似物；替诺福韦。
本文受版权保护。版权所有。 作者: StephenW 时间: 2021-12-11 13:53
ssHepatocellular carcinoma after treatment cessation in non-cirrhotic HBeAg-negative chronic hepatitis B: A multicenter cohort study
Margarita Papatheodoridi 1 2 , Tung-Hung Su 3 , Emilia Hadziyannis 4 , Chun-Hsun Liao 3 , Αfroditi Orfanidou 1 , Hung-Chi Yang 3 , Kalliopi Zachou 5 , Chun-Jen Liu 3 , Anastasia Kourikou 4 , Nikolaos Gatselis 5 , Spilios Manolakopoulos 1 4 , George Dalekos 5 , Jia-Horng Kao 3 , Stephanos Hadziyannis 4 , George Papatheodoridis 1
Affiliations
Affiliations
1
Department of Gastroenterology, National and Kapodistrian University of Athens School of Health Sciences, General Hospital of Athens "Laiko", Athens, Greece.
2
University College of London, Institute of Liver and Digestive Health, Royal Free Campus, London, UK.
3
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
4
2nd Department of Internal Medicine, National and Kapodistrian University of Athens School of Health Sciences, General Hospital of Athens "Hippokratio", Athens, Greece.
5
Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece.
PMID: 34890120 DOI: 10.1111/liv.15128
Abstract
Background & aims: Scarce data exist on the effect of nucleos(t)ide analogue (NA) discontinuation on hepatocellular carcinoma (HCC) risk in HBeAg-negative chronic hepatitis B (CHBe-). Therefore, we assessed whether HCC risk is increased in non-cirrhotic CHBe- patients who discontinue compared to those remaining on NAs.
Methods: This cohort study included 650 consecutive non-cirrhotic Caucasian or Asian patients with CHBe- without a history of HCC who discontinued NAs after a median of 5 or 3 years (cases, n=325; Caucasians: 143, Asians: 182) or remained on NA therapy beyond 5 or 3 years, respectively (controls, n=325; Caucasians: 223, Asians: 102). Propensity-score (PS) 1:1 matching was applied to adjust for patients' origin, age and sex.
Results: During median follow-up of 44 months, HCC developed in 7/325 cases and 9/325 controls or 7/245 PS-matched cases and 7/245 PS-matched controls with 5-year cumulative HCC incidence of 5.1% and 4.9%, respectively (log-rank, P=0.836). No difference in 5-year HCC risk was observed between cases and controls of Caucasian (3.0% vs 4.8%; log-rank, P=0.510) or Asian origin (1.3% vs 2.2%; log-rank, P=0.873). In both cases and controls, HCC incidence was independently associated with age and PAGE-B score. In cases alone, HCC development after NA discontinuation was associated only with pretreatment platelet counts and PAGE-B score, but not with any type of relapse or HBsAg loss.
Conclusions: Our findings suggest that discontinuation of effective long-term NA therapy in non-cirrhotic CHBe- patients is not associated with increased HCC risk, which is not affected by post-NA relapses and/or HBsAg loss.