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

Seung Up Kim1,2,3, Yeon Seok Seo4, Han Ah Lee4

  • 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
|January 29, 2020
PubMed

Insights

Long-term antiviral therapy for chronic hepatitis B (CHB) does not significantly alter hepatocellular carcinoma (HCC) risk over time. Continued vigilance and HCC surveillance remain crucial for patients undergoing treatment.

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.
Abstract

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