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Predictive factors for risk of hepatocellular carcinoma in immune inactive chronic hepatitis B
Seung In Seo1, Hyoung Su Kim1, Bo Kyung Yang1
1Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Sungnae-gil, Kangdong-gu, Seoul, Republic of Korea 134-701.
Insights
Cirrhosis and elevated ALT levels are key predictors of hepatocellular carcinoma (HCC) in immune inactive chronic hepatitis B (CHB). Closer monitoring is recommended for CHB patients with these risk factors to prevent HCC development.
Area of Science:
- Hepatology
- Oncology
- Virology
Background:
- Risk factors for hepatocellular carcinoma (HCC) in immune inactive chronic hepatitis B (CHB) remain unclear.
- Understanding these factors is crucial for early detection and prevention strategies.
Purpose of the Study:
- To identify predictive factors for HCC development in patients with immune inactive CHB.
- To clarify the risk associated with specific clinical and biochemical markers.
Main Methods:
- A cohort of 337 patients with immune inactive CHB was followed from 1995 to 2017.
- Univariate and multivariate analyses, including Cox regression, were used to identify independent risk factors.
- Follow-up averaged 63 months, with HCC incidence recorded.
Main Results:
- The overall HCC incidence was 4.5% (15/337) during the follow-up period.
- Independent predictors for HCC were the presence of cirrhosis (HR, 11.768) and ALT elevation >2x ULN (HR, 3.774).
- Cumulative HCC incidence at 10 years increased significantly with the number of risk factors (6.3% to 63.5%).
Conclusions:
- Underlying cirrhosis and hepatic inflammation (indicated by ALT elevation) are significant HCC predictors in immune inactive CHB.
- ALT elevation and cirrhosis have a synergistic effect on HCC development.
- Patients with high ALT levels, particularly those with cirrhosis, require intensified HCC surveillance.
Background And Aims:
The risk factors for hepatocellular carcinoma (HCC) in immune inactive chronic hepatitis B (CHB) have not been clarified. The aim of this study was to investigate the predictive factors for HCC inimmune inactive CHB.
Methods:
A total of 337 patients in immune inactive CHB were consecutively enrolled in Kangdong Sacred Heart Hospital from 1995 to 2017. Univariate and multivariate analyses were performed to identify the independent risk factors for HCC development.
Results:
During the mean 63 months of follow-up, the incidence of HCC of study population was 4.5% (15/337). Patients who developed HCC were older, had more cirrhosis at baseline, and were more likely to experience ALT elevation>2 X upper limit of normal (ULN) during follow-up than those without HCC. In Cox regression analysis, increased ALT levels>2 X ULN during follow-up (hazard ratio [HR], 3.774; 95% confidence interval [CI], 1.145-12.443; P=0.029] and presence of cirrhosis (HR, 11.768; 95% CI, 3.350-41.336; P<0.001) were identified as the independent factors for HCC in immune inactive CHB. With increasing number of risk factors, the respective cumulative incidence of HCC at 10 years was 6.3%, 8.8%, and 63.5%.
Conclusions:
Underlying cirrhosis and hepatic inflammation reflected by increased ALT levels>2 X ULN were significant predictors for HCC in immune inactive CHB. ALT elevation showed a synergistic effect in HCC development combined with cirrhosis. It suggests that patients with high serum ALT levels, especially those with cirrhosis, are required closer surveillance for HCC even in immune inactive CHB.
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