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Steatosis, HBV-related HCC, cirrhosis, and HBsAg seroclearance: A systematic review and meta-analysis
Xianhua Mao1, Ka Shing Cheung1,2, Chengzhi Peng3
1Department of Medicine, School of Clinical Medicine , The University of Hong Kong , Hong Kong.
Insights
Hepatic steatosis increases hepatocellular carcinoma (HCC) and cirrhosis risk in chronic hepatitis B (CHB) patients. However, it also correlates with a higher chance of HBsAg seroclearance, indicating a need for careful management.
Area of Science:
- Hepatology
- Gastroenterology
- Oncology
Background:
- Non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis B (CHB) are leading causes of hepatocellular carcinoma (HCC).
- The specific impact of hepatic steatosis on HCC development in CHB patients, and its relationship with cirrhosis, fibrosis, and HBsAg seroclearance, remains debated.
Purpose of the Study:
- To investigate the association between hepatic steatosis and HCC risk in CHB patients.
- To explore the link between hepatic steatosis and the development of cirrhosis, advanced fibrosis, and HBsAg seroclearance in CHB.
Main Methods:
- A systematic review and meta-analysis of observational studies was conducted.
- Data were sourced from PubMed, EMBASE, and Cochrane Library up to February 1, 2022.
- Pooled odds ratios (ORs) were calculated to assess associations, with subgroup and sensitivity analyses performed for robustness.
Main Results:
- Thirty-four studies comprising 68,268 CHB patients were analyzed.
- Hepatic steatosis was significantly associated with increased odds of HCC (OR, 1.59) and cirrhosis (OR, 1.52).
- Steatosis also correlated with a higher likelihood of HBsAg seroclearance (OR, 2.22), but not significantly in patients on nucleos(t)ide analogues.
Conclusions:
- Hepatic steatosis is linked to a higher risk of HCC and cirrhosis in CHB patients.
- Concomitant steatosis in CHB patients is associated with an increased chance of achieving functional cure (HBsAg seroclearance).
- Identifying and managing hepatic steatosis in CHB patients is crucial for risk stratification and treatment optimization.
Background And Aims:
NAFLD and chronic hepatitis B (CHB) infection are common etiologies of HCC. The impact of hepatic steatosis on HCC in CHB, as well as its relationship with the development of cirrhosis, fibrosis, and HBsAg seroclearance, remains controversial.
Approach And Results:
Data from observational studies were collected through PubMed, EMBASE, and the Cochrane Library from inception to February 1, 2022. Outcomes of interest included the association of hepatic steatosis with HCC, cirrhosis, advanced fibrosis, and HBsAg seroclearance, expressed in terms of pooled ORs. Additional subgroup and sensitivity analyses were performed to validate the robustness of findings. A total of 34 studies with 68,268 patients with CHB were included. Hepatic steatosis was associated with higher odds of HCC (OR, 1.59; 95% CI, 1.12-2.26; I2 = 72.5%), with the association remaining consistent in Asia (OR, 1.56; 95% CI, 1.08-2.25), studies with a median follow-up duration of ≥5 years (OR, 2.82; 95% CI, 1.57-5.08), exclusion of alcohol use (OR, 1.71; 95% CI, 1.01-2.91), and biopsy-proven steatosis (OR, 2.86; 95% CI, 1.61-5.06), although no significant association was noted among nucleos(t)ide analogue-treated patients (OR, 1.05; 95% CI, 0.62-1.77). Steatosis was associated with the development of cirrhosis (OR, 1.52; 95% CI, 1.07-2.16; I2 = 0%) and HBsAg seroclearance (OR, 2.22; 95% CI, 1.58-3.10; I2 = 49.0%).
Conclusions:
Hepatic steatosis was associated with an increased risk of HCC and cirrhosis among patients with CHB but with a higher chance of achieving a functional cure, highlighting the importance of identifying concomitant steatosis in CHB.
