AASLD2014:肝细胞癌（HCC）的非肝硬化慢性乙型肝炎（CHB）患者

StephenW

1852Incidence of Hepatocellular Carcinoma (HCC) in non-cirrhotic chronic hepatitis B (CHB) patients with low ALT levels in a multicenter US CohortJoseph K. Hoang1, Nghia H. Nguyen2, Derek Lin3, Vinh D. Vu1, Huy N. Trinh4, Jiayi Li5, Jian Q. Zhang6, Huy A. Nguyen4, Khanh Nguyen4, Mindie H. Nguyen1;1Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA; 2School of Medicine, University of California, San Diego, San Diego, CA; 3Department of Medicine, Stanford University Medical Center, Palo Alto, CA; 4San Jose Gastroenterology, San Jose, CA; 5Gastroenterology, Palo Alto Medical Foundation, Palo Alto, CA; 6Primary Care, Chinese Hospital, San Francisco, CABackground: AASLD treatment guideline for CHB recommends ALT ≥ two times the upper limit of normal (ULN) as one of the major criteria to initiate antiviral therapy. However, patients with ALT < 2× ULN may not be free from future risk of liver complications such as hepatocellular carcinoma (HCC). Our aim is to compare the risk of HCC for non-cirrhotic CHB patients by an ALT levels and by treatment status. Method: We performed a retrospective cohort study of 1814 consecutive treatment-naïve, noncirrhotic CHB patients aged 40 or older whose follow-up was 12 months or longer from 1991-2014 at four U.S. medical clinics. ALT of ≥2× ULN was defined by gender (≥60 for men, ≥ 38 for women). Survival analysis with Kaplan Meier curves were produced to capture the rate of HCC development by ALT level and in those who were treated versus those who remained untreated. Annual incidence was reported in cases per 1000 person-years. Results: The majority of patients were males (59%), had HBeAg-negative status (85%), and had a mean age of 52.5 ± 9.8. Median years of follow-up was 4 (1-10) years. Baseline median ALT and log10 HBV DNA were 34 (3-3478) U/L and 4.2 (0-11.9) logIU/mL, respectively. A total of 23 patients developed HCC during follow-up. In patients with ALT ≥2× ULN, those who were treated had a lower incidence of HCC than those who were untreated (p<0.02) (Figure 1). HCC incidence was 4.9 cases per 1000 person-years in untreated patients and zero cases in treated patients. In patients who had ALT <2× ULN, there was a trend for patients who received treatment to have a lower rate of HCC than those who were untreated (p=0.15) (Figure 1). The annual HCC incidence was 3.5 cases per 1000 person untreated and 1.2 cases per 1000 person in treated patients. Conclusion: Antiviral therapy significantly reduced HCC risk for patients with ALT > 2× ULN. HCC incidence is also high in CHB patients without cirrhosis even at ALT < 2× ULN, especially if they remain untreated.

Disclosures:
Huy N. Trinh - Advisory Committees or Review Panels: BMS, Gilead; Grant/ Research Support: BMS, Gilead; Speaking and Teaching: BMS, Gilead, vertex; Stock Shareholder: Gilead
Huy A. Nguyen - Advisory Committees or Review Panels: Gilead, BMS; Speaking and Teaching: Gilead
Mindie H. Nguyen - Advisory Committees or Review Panels: Bristol-Myers Squibb, Bayer AG, Gilead, Novartis, Onyx; Consulting: Gilead Sciences, Inc.; Grant/Research Support: Gilead Sciences, Inc., Bristol-Myers Squibb, Novartis Pharmaceuticals, Roche Pharma AG, Idenix, Hologic, ISIS
The following people have nothing to disclose: Joseph K. Hoang, Nghia H. Nguyen, Derek Lin, Vinh D. Vu, Jiayi Li, Jian Q. Zhang, Khanh Nguyen