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Revised Korean Antiviral Guideline Reduces the Hepatitis B-related Hepatocellular Carcinoma Risk in Cirrhotic

David Sooik Kim1, Soo Young Park2, Beom Kyung Kim1,3

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

Journal of Korean Medical Science
|April 27, 2021
PubMed

Insights

Implementing the revised Korean Association for the Study of Liver guideline for antiviral therapy in chronic hepatitis B cirrhosis patients significantly reduced hepatocellular carcinoma risk and improved prognosis. This change enhanced patient outcomes in South Korea.

Area of Science:

  • Hepatology
  • Viral Hepatitis
  • Oncology

Background:

  • Chronic hepatitis B (CHB) cirrhosis patients in South Korea initiated antiviral therapy (AVT) under a revised Korean Association for the Study of Liver (KASL) guideline since September 2015.
  • The guideline mandated AVT reimbursement for CHB cirrhosis patients with HBV DNA ≥ 2,000 IU/L, irrespective of liver enzyme levels.

Purpose of the Study:

  • To evaluate the impact of the revised KASL guideline implementation on the risk of hepatocellular carcinoma (HCC) in CHB cirrhosis patients.
  • To assess if the guideline change influenced patient prognosis, including HCC development and mortality.

Main Methods:

  • A cohort of 429 CHB cirrhosis patients initiating AVT between 2014 and 2016 was analyzed.
  • Patients were categorized into two groups: pre-guideline implementation (AVT initiated before Sept 2015) and post-guideline implementation (AVT initiated after Sept 2015).
  • Risk of HCC development and mortality were compared between the two groups using univariate and multivariate analyses.

Main Results:

  • AVT initiation before the guideline, older age, male gender, and diabetes were significant predictors of increased HCC risk.
  • Multivariate analysis confirmed that AVT initiation before the guideline (HR=1.941), older age (HR=5.762), male gender (HR=2.555), and diabetes (HR=1.568) independently predicted higher HCC risk.
  • AVT initiation before the guideline (HR=2.309), male gender (HR=3.058), and lower platelet count (HR=0.989) independently predicted increased mortality.
  • Cumulative incidences of HCC and mortality were significantly higher in the pre-guideline group compared to the post-guideline group.

Conclusions:

  • The implementation of the revised KASL guideline improved the prognosis for CHB cirrhosis patients receiving AVT.
  • Starting AVT after the guideline revision was associated with a reduced risk of HCC and mortality.
Abstract

Keywords:
Antiviral TherapyGuidelineHepatitis BHepatocellular CarcinomaManagement

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