HBsAg Seroclearance in Chronic Hepatitis B: Implications for HCC

liver411

J Clin Gastroenterol. 2010 Jun 8. [Epub ahead of print]

HBsAg Seroclearance in Chronic Hepatitis B: Implications for Hepatocellular
Carcinoma.

Kim JH, Lee YS, Lee HJ, Yoon E, Jung YK, Jong ES, Lee BJ, Seo YS, Yim HJ, Yeon
JE, Park JJ, Kim JS, Bak YT, Byun KS.

Department of Internal Medicine, Korea University College of Medicine, Seoul,
South Korea.

Abstract
GOALS AND BACKGROUND: The long-term clinical course, including the development
of hepatocelluar carcinoma (HCC) after hepatic B surface antigen (HBsAg)
seroclearance is not established. We discovered that the incidence of HCC and
the risk factors for HCC in chronic hepatitis B (CHB) patients after HBsAg
seroclearance. STUDY: During 28 years, 96 CHB patients with HBsAg
seroclearance were retrospectively reviewed. These patients continued to
undergo HCC surveillance. The median follow-up time from initial visit was
166.5 months (range, 7 to 321 mo). RESULTS: The mean age at the initial visit
and at the time of seroclearance was 39.2+/-10.6 years and 46.4+/-9.9 years,
respectively. The mean age at the time of HBsAg seroclearance was
significantly lower (P=0.03) in patients with spontaneous HBsAg seroclearance
than patients with treatment-associated HBsAg seroclearance. During a median
of 56 months (range, 7 to 238 mo) of follow-up after HBsAg seroclearance, 6
(6.5%) patients developed HCC. The mean age at the time of developing HCC was
55.8+/-10.3 years. On univariate analysis, the evidence of liver cirrhosis
from the time of HBsAg seroclearance and age more than 45 years at the time of
HBsAg seroclearance were significant risk factors for HCC development. In
multivariate analysis, the evidence of liver cirrhosis at HBsAg seroclearance
was the only significant risk factor for HCC development. CONCLUSIONS: HCC can
develop after HBsAg seroclearance in patients with known cirrhosis. Patients
who achieved HBsAg seroclearance at older age (>45) may have undiagnosed
cirrhosis and hence remain at risk for HCC. HCC surveillance should be carried
out for both of those patient populations.
PMID: 20535028 [PubMed - as supplied by publisher]



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