Risk factors for hepatocellular carcinoma at baseline and 1 year after initiation of nucleos(t)ide analog therapy for chronic hepatitis B
Shun Kaneko 1 2 , Masayuki Kurosaki 1 , Toshie Mashiba 3 , Hiroyuki Marusawa 4 , Masahiko Kondo 5 , Yuji Kojima 6 , Yasushi Uchida 7 , Hideki Fujii 8 , Takehiro Akahane 9 , Hitoshi Yagisawa 10 , Atsunori Kusakabe 11 , Haruhiko Kobashi 12 , Takehiko Abe 13 , Hideo Yoshida 14 , Chikara Ogawa 15 , Koichiro Furuta 16 , Nobuharu Tamaki 1 , Keiji Tsuji 17 , Tomomichi Matsushita 18 , Namiki Izumi 1 , Japanese Red Cross Liver Study Group
Affiliations
Affiliations
1
Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
2
Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan.
3
Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Ehime, Japan.
4
Department of Gastroenterology, Japanese Red Cross Osaka Hospital, Osaka, Japan.
5
Department of Gastroenterology, Japanese Red Cross Otsu Hospital, Shiga, Japan.
6
Department of Gastroenterology, Japanese Red Cross Ise Hospital, Mie, Japan.
7
Department of Gastroenterology, Japanese Red Cross Matsue Hospital, Shimane, Japan.
8
Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
9
Department of Gastroenterology, Japanese Red Cross Ishinomaki Hospital, Miyagi, Japan.
10
Department of Gastroenterology, Japanese Red Cross Akita Hospital, Akita, Japan.
11
Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.
12
Department of Hepatology, Japanese Red Cross Okayama Hospital, Okayama, Japan.
13
Department of Gastroenterology, Japanese Red Cross Maebashi Hospital, Gunma, Japan.
14
Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan.
15
Department of Gastroenterology, Japanese Red Cross Takamatsu Hospital, Kagawa, Japan.
16
Department of Gastroenterology, Japanese Red Cross Masuda Hospital, Shimane, Japan.
17
Department of Gastroenterology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan.
18
Department of Gastroenterology, Japanese Red Cross Gifu Hospital, Gifu, Japan.
PMID: 36222204 DOI: 10.1002/jmv.28210
Abstract
Background/aims: Nucleos(t)ide analogs (NA) cannot completely suppress the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). This study aimed to identify the risk factors for HCC development in naïve CHB patients treated with current NA.
Methods: Patients receiving NA (n = 905) were recruited retrospectively from the 17 hospitals of the Japanese Red Cross Liver Study Group. All treatment-naïve patients had been receiving current NA continuously for more than one year until the end of the follow-up. We analyzed the accuracy of predictive risk score using area under receiver operating characteristic curve.
Results: The albumin-bilirubin (ALBI) score was significantly improved by NA therapy (-0.171 ± 0.396; p < 0.001 at week 48). A total of 72 (8.0%) patients developed HCC over a median follow-up of 6.2 (1.03-15.7) years. An independent predictive factor of HCC development was older age, cirrhosis, lower platelet counts at baseline and ALBI score, and alpha-fetoprotein (AFP) at 1 year after NA therapy according to multivariate analysis. The accuracy was assessed using the PAGE-B, mPAGE-B, aMAP, APA-B, and REAL-B scores that included these factors. Discrimination was generally acceptable for these models. aMAP and REAL-B demonstrated high discrimination with 0.866/0.862 and 0.833/0.859 for 3- and 5- years prediction from the status of one year after NA therapy, respectively.
Conclusion: Baseline age and platelet count, as well as ALBI and AFP one year after NA, were useful for stratifying carcinogenesis risk. The aMAP and REAL-B scores were validated with high accuracy in Japanese CHB patients. This article is protected by copyright. All rights reserved.
Keywords: Hepatitis B virus; albumin-bilirubin score; hepatocellular carcinoma; nucleos(t)ide analogs.
This article is protected by copyright. All rights reserved.