Hepatocellular Carcinoma Risk Steadily Persists over Time Despite Long-Term Antiviral Therapy for Hepatitis B: A...

Area of Science:

• Hepatology
• Oncology
• Virology

Background:

• Chronic hepatitis B (CHB) is a significant risk factor for hepatocellular carcinoma (HCC).
• Long-term antiviral therapy (AVT) is a standard treatment for CHB, aiming to reduce HCC incidence.
• Assessing temporal trends in HCC incidence during AVT is critical for patient management.

Purpose of the Study:

• To evaluate the incidence of hepatocellular carcinoma (HCC) over time in Asian patients with chronic hepatitis B (CHB) undergoing long-term antiviral therapy (AVT).
• To compare HCC incidence rates during the first 5 years versus after 5 years of entecavir/tenofovir (ETV/TDF) treatment.
• To investigate the impact of AVT duration on HCC risk in a Korean CHB cohort.

Main Methods:

• Retrospective cohort study of 3,156 CHB patients receiving first-line entecavir/tenofovir (ETV/TDF) from four Korean academic hospitals.
• Comparison of HCC incidence rates during the first 5 years and after 5 years of ETV/TDF treatment.
• Stratification by modified PAGE-B score and Poisson regression analysis to assess AVT duration's effect on HCC incidence.

Main Results:

• The annual incidence of HCC per 100 person-years was similar during the first 5 years (1.93%) and after 5 years (2.27%) of AVT.
• Stratification by HCC risk groups (low, intermediate, high) showed no significant difference in annual HCC incidence rates over time.
• Poisson regression analysis revealed that AVT duration did not significantly affect the overall trend of HCC incidence (adjusted IRR = 0.85, P = 0.232).

Conclusions:

• Long-term antiviral therapy for CHB in the Republic of Korea, where HBV genotype C2 is prevalent, does not eliminate the persistent risk of HCC.
• The incidence of HCC remains statistically similar over extended periods of AVT.
• Continuous and careful HCC surveillance is essential for all patients with CHB, irrespective of AVT duration.