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Risk Stratification of Hepatocellular Carcinoma in Hepatitis B Virus e Antigen–Negative Carriers by Combining Viral Biomarkers
Tai-Chung Tseng1,3,7,
Chun-Jen Liu2,3,
Chi-Ling Chen3,
Hung-Chih Yang2,6,
Tung-Hung Su2,3,
Chia-Chi Wang1,7,
Wan-Ting Yang4,
Stephanie Fang-Tzu Kuo8,
Chen-Hua Liu2,3,
Pei-Jer Chen2,3,
Ding-Shinn Chen2,3 and
Jia-Horng Kao2,3,4,5
+ Author Affiliations
1Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital Taipei Branch, New Taipei
2Division of Gastroenterology, Department of Internal Medicine
3Graduate Institute of Clinical Medicine
4Hepatitis Research Center
5Department of Medical Research
6Department of Microbiology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei
7School of Medicine, Tzu Chi University, Hualien, Taiwan
8St. Vincent's Hospital, Melbourne, Australia
Correspondence: Jia-Horng Kao, MD, PhD, Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te St, Taipei 10002, Taiwan ([email protected]).
Abstract
Background. The serum hepatitis B virus (HBV) surface antigen (HBsAg) level can predict hepatocellular carcinoma (HCC) development in hepatitis B e antigen (HBeAg)–negative patients with an HBV DNA level of <2000 IU/mL. However, little is known regarding how well the combination of both viral biomarkers stratifies HCC risk.
Methods. A total of 2165 Taiwanese HBeAg-negative noncirrhotic patients were followed for 14.9 years. The predictive power of the HBsAg level for HCC was analyzed for different viral load ranges.
Results. In patients with HBV DNA levels of 2000–19 999 IU/mL (intermediate viral load), a positive correlation between HBsAg level and HCC development was identified after adjustment for other risk factors (P = .002). In contrast, no association was found between HBsAg level and HCC in patients with higher viral loads. HBsAg level was subsequently included to stratify HCC risk in patients with low and intermediate viral loads. Receiver operating characteristic curve analysis showed that combining HBV DNA and HBsAg level better predicts 10-year HCC development as compared to using HBV DNA level alone in the overall cohort (P = .028).
Conclusions. Serum HBsAg level helps stratify HCC risk in patients with intermediate viral loads. Combining HBV DNA and HBsAg levels better predicts HCC risk
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