Non-invasive imaging criteria for the diagnosis of hepatocellular carcinoma in non-cirrhotic patients with chronic hepatitis B

Abstract Background: Nucleos(t)ide analogues (NUCs) were proved to reduce hepatocellular carcinoma (HCC) development in patients with chronic hepatitis B (CHB) infection, but data was limited on the efficacy in the CHB patients with cirrhosis. Methods: We retrospectively analyzed data from 447 patients with CHB-related cirrhosis, who initiated tenofovir/entecavir therapy during April 2007 and August 2013. They were divided into HCC (n=48) and non-HCC (n=399) groups. The mean follow-up period was 63.2 ± 34.2 months.Results: Forty-eight patients (10.7%) developed HCC during surveillance. The annual incidence rate of HCC was 2.04 (95% CI: 1.52–2.68) per 100 person-year. The cumulative incidence of HCC was 0.9%, 9.8% and 22.1% at the 1, 5 and 10 years, respectively. Significant predictors for HCC identified using multiple Cox regression analysis were age ≥50 years (hazard ratio [HR]: 2.34, 95% confidence interval [CI] = 1.08–5.1) and α-fetoprotein (AFP) ≥8 ng/ml (HR: 2.05, 95% CI = 1.1–3.84). The incidence rate of HCC was further analyzed in subgroups according to the risk factors identified by multivariate cox regression. The incidence rate of HCC was 8.67-fold higher in patients with age ≥50 years and AFP ≥8 ng/ml (3.14 per 100 person-year, 95% CI = 1.99–4.72) than those with age <50 years and AFP <8 ng/ml (0.36 per 100 person-year, 95% CI = 0.06–1.19).Conclusion: The cirrhotic CHB patients with age <50 years and AFP <8 ng/ml have the lowest annual incidence of HCC. However, the cirrhotic patients with age ≥50 years or/and AFP ≥8 ng/ml have significantly higher risk for HCC and warrant careful surveillance schedule for HCC development.

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Chronic hepatitis B exhibited higher rate of hepatocellular carcinoma occurrence than hepatitis C in cirrhotic patients after effective antiviral treatment

Journal of the Formosan Medical Association ◽

10.1016/j.jfma.2020.07.019 ◽

2021 ◽

Vol 120 (1) ◽

pp. 621-628

Author(s):

Ming-Tsung Lin ◽

Kuo-Chin Chang ◽

Yi-Hao Yen ◽

Ming-Chao Tsai ◽

Chien-Hung Chen ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Chronic Hepatitis ◽

Hepatitis C ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Antiviral Treatment ◽

Cirrhotic Patients

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Role of hepatitis D virus infection in development of hepatocellular carcinoma among chronic hepatitis B patients treated with nucleotide/nucleoside analogues

Scientific Reports ◽

10.1038/s41598-021-87679-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tyng-Yuan Jang ◽

Yu-Ju Wei ◽

Ta-Wei Liu ◽

Ming-Lun Yeh ◽

Shu-Fen Liu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Chronic Hepatitis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Nucleoside Analogues ◽

Hepatitis D ◽

Hepatitis D Virus ◽

Cirrhotic Patients ◽

Hdv Infection

AbstractHepatitis D virus (HDV) infection increases the risk of hepatocellular carcinoma (HCC) in the natural course of chronic hepatitis B (CHB) patients. Its role in patients treated with nucleotide/nucleoside analogues (NAs) is unclear. We aimed to study the role of hepatitis D in the development of HCC in CHB patients treated with NAs. Altogether, 1349 CHB patients treated with NAs were tested for anti-HDV antibody and RNA. The incidence and risk factors of HCC development were analyzed. Rates of anti-HDV and HDV RNA positivity were 2.3% and 1.0%, respectively. The annual incidence of HCC was 1.4 per 100 person-years after a follow-up period of over 5409.5 person-years. The strongest factor association with HCC development was liver cirrhosis (hazard ratio [HR]/95% confidence interval [CI] 9.98/5.11–19.46, P < 0.001), followed by HDV RNA positivity (HR/ CI 5.73/1.35–24.29, P = 0.02), age > 50 years old (HR/CI 3.64/2.03–6.54, P < 0.001), male gender (HR/CI 2.69/1.29–5.60, P: 0.01), and body mass index (BMI, HR/CI 1.11/1.03–1.18, P = 0.004). The 5-year cumulative incidence of HCC was 7.3% for patients with HDV RNA negativity compared to that of 22.2% for patients with HDV RNA positivity (P = 0.01). In the subgroup of cirrhotic patients, the factors associated with HCC development were HDV RNA positivity (HR/CI 4.45/1.04–19.09, P = 0.04) and BMI (HR/CI 1.11/1.03–1.19, P = 0.01). HDV viremia played a crucial role in HCC development in CHB patients who underwent NA therapy.

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