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Risk of hepatocellular carcinoma in cirrhotic hepatitis B virus patients during nucleoside/nucleotide analog therapy

Etsuro Orito1, Chitomi Hasebe2, Masayuki Kurosaki3

  • 1Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.

Hepatology Research : the Official Journal of the Japan Society of Hepatology
|September 23, 2014
PubMed
Abstract

Insights

Hepatocellular carcinoma (HCC) risk during nucleoside/nucleotide analog (NA) therapy is linked to liver cirrhosis and treatment duration. Achieving hepatitis B surface antigen (HBsAg) seroclearance eliminates HCC development risk.

Area of Science:

  • Hepatology
  • Virology
  • Oncology

Background:

  • Hepatocellular carcinoma (HCC) can develop during nucleoside/nucleotide analog (NA) therapy for chronic hepatitis B virus (HBV) infection, even with controlled viral load and liver enzymes.
  • Identifying risk factors for HCC development during NA therapy is crucial for patient management.

Purpose of the Study:

  • To identify risk factors associated with hepatocellular carcinoma (HCC) development in patients undergoing nucleoside/nucleotide analog (NA) therapy for chronic hepatitis B virus (HBV) infection.
  • To evaluate the impact of treatment response markers on HCC incidence.

Main Methods:

  • Analysis of 602 patients receiving continuous NA therapy for chronic HBV infection.
  • Exclusion of patients with prior HCC or HCC within one year of therapy initiation.
  • Assessment of risk factors including liver cirrhosis (LC) status, chronic hepatitis (CH) status, and duration of NA therapy.

Main Results:

  • The overall incidence of HCC was 6.1% over a median therapy duration of 90 months.
  • Significant risk factors for HCC development were identified as liver cirrhosis (LC) status and longer duration of NA therapy.
  • Patients with LC had a higher annual HCC incidence (2.53%/year) compared to those with CH (0.34%/year).
  • Normalization of ALT, loss of HBV DNA, and HBeAg seroconversion showed some reduction in HCC incidence.
  • No HCC cases were observed in patients who achieved hepatitis B surface antigen (HBsAg) seroclearance during NA therapy.

Conclusions:

  • Liver cirrhosis (LC) status is a significant risk factor for HCC development during NA therapy.
  • Hepatitis B surface antigen (HBsAg) seroclearance during NA therapy is associated with a complete absence of HCC development.
  • Achieving HBsAg seroclearance should be the ultimate therapeutic goal to minimize HCC risk in chronic HBV patients.
Keywords:
hepatitis B surface antigen seroclearancehepatitis B virus DNAhepatocellular carcinomaliver cirrhosisnucleoside/nucleotide analog therapyrisk factors

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