Steatosis, HBV-related hepatocellular carcinoma, cirrhosis & HBsAg seroclearance: a systematic review and meta-analysis
Xianhua Mao 1 , Ka Shing Cheung 1 2 , Chengzhi Peng 3 , Lung-Yi Mak 1 4 , Ho Ming Cheng 1 , James Fung 1 4 , Noam Peleg 5 6 , Howard H-W Leung 7 , Rajneesh Kumar 8 9 , Jeong-Hoon Lee 10 , Amir Shlomai 11 , Man-Fung Yuen 1 4 , Wai-Kay Seto 1 2 4
Affiliations
Affiliations
1
Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong.
2
Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen.
3
Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
4
State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong.
5
The Division of Gastroenterology, Rabin Medical Center, Petach Tikva, Israel.
6
Sackler school of Medicine, Tel Aviv University, Tel Aviv, Israel.
7
Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong.
8
Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
9
Duke-NUS Graduate Medical School, Singapore.
10
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
11
Department of Medicine D and The Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
PMID: 36111362 DOI: 10.1002/hep.32792
Abstract
Background & aim: Non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis B (CHB) infection are common aetiologies of hepatocellular carcinoma (HCC). The impact of hepatic steatosis on HCC in CHB, as well as its relationship with the development of cirrhosis, fibrosis and hepatitis B surface antigen (HBsAg) seroclearance, remains controversial.
Approach & results: Data of observational studies were collected via PubMed, EMBASE and Cochrane Library from inception to February 1, 2022. Outcomes of interest included the association of hepatic steatosis with HCC, cirrhosis, advanced fibrosis and HBsAg seroclearance, expressed in terms of pooled odds ratios (ORs). Additional sub-group and sensitivity analyses were performed to validate robustness of findings. A total of 34 studies with 68,268 CHB patients were included. Hepatic steatosis was associated with higher odds of HCC (OR 1.59; 95%CI 1.12-2.26; I2 =72.5%), with the association remaining consistent in Asia (OR 1.56; 95%CI 1.08-2.25), studies with a median follow-up duration of ≥5 years (OR 2.82; 95%CI 1.57-5.08), exclusion of alcohol use (OR 1.71; 95%CI 1.01-2.91) and biopsy-proven steatosis (OR 2.86; 95%CI 1.61-5.06), although no significant association was noted among nucleos(t)ide analogue-treated patients (OR 1.05; 95%CI 0.62-1.77). Steatosis was associated with the development of cirrhosis (OR 1.52; 95%CI 1.07-2.16; I2 =0%) and HBsAg seroclearance (OR 2.22; 95%CI 1.58-3.10; I2 =49.0%).
Conclusions: Hepatic steatosis was associated with an increased risk of HCC and cirrhosis among CHB patients, but with a higher chance of achieving a functional cure, highlighting the importance of identifying concomitant steatosis in CHB.
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