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A Lower HCC Incidence in Chronic HBV-Infected Patients Recovered from Acute-on-Chronic Liver Failure: A Prospective
Jianhua Yin1, Xiang Xu2,3, Rui Pu1
1Department of Epidemiology, Second Military Medical University, Shanghai, China.
Insights
A hepatitis B virus-acute-on-chronic liver failure (HBV-ACLF) episode may decrease hepatocellular carcinoma (HCC) risk in patients with chronic liver disease. This study developed a nomogram to predict HCC occurrence in these patients.
Area of Science:
- Hepatology
- Oncology
- Virology
Background:
- Chronic hepatitis B virus (HBV) infection activation can lead to acute-on-chronic liver failure (ACLF).
- The impact of HBV-ACLF episodes on hepatocellular carcinoma (HCC) development is not well understood.
Purpose of the Study:
- To investigate the effect of HBV-ACLF episodes on the incidence of HCC.
- To identify risk factors for HCC development in patients with chronic HBV infection.
- To develop a predictive model for HCC occurrence in HBV-related liver disease.
Main Methods:
- Prospective cohort study involving 769 HBV-ACLF patients and 2114 HBV-related chronic liver disease (HBV-CLD) patients.
- Propensity score matching was used to balance baseline characteristics between cohorts.
- Multivariate Cox regression analysis and nomogram construction were employed to assess HCC risk and predict outcomes.
Main Results:
- The cumulative incidence of HCC was significantly lower in the HBV-ACLF cohort compared to the HBV-CLD cohort (5.77/1000 vs. 9.78/1000 person-years).
- HBV-ACLF episodes independently reduced HCC risk, irrespective of liver cirrhosis or family history of HCC.
- Older age, male sex, liver cirrhosis, and low platelet count were identified as independent risk factors for HCC.
- A nomogram demonstrated good predictive accuracy for 3-year HCC probability (AUC = 0.812).
Conclusions:
- An episode of HBV-ACLF is associated with a decreased risk of developing HCC in patients with chronic HBV infection.
- Older age and liver cirrhosis are significant independent predictors of HCC occurrence.
- The developed nomogram provides a reliable tool for predicting HCC risk in patients with HBV-related liver disease.
Background:
Activation of chronic hepatitis B virus (HBV) infection is an important cause of acute-on-chronic liver failure (ACLF). However, the effect of HBV-ACLF episode on hepatocellular carcinoma (HCC) occurrence remains largely unknown.
Methods:
A total of 769 HBV-ACLF patients and 2114 HBV-related chronic liver disease (HBV-CLD) patients diagnosed between August 1998 and December 2011 were enrolled in this prospective cohort study. Of the HBV-CLD patients, 380 received lifetime antiviral treatment with nucleos(t)ide analogues. Propensity score matching was applied to reduce baseline differences between HBV-ACLF and HBV-CLD cohorts.
Results:
The survival rate of HBV-ACLF patients was 53.6%, 50.3%, 47.8%, and 46.2% at 90-day, 1-year, 5-year, and 10-year, respectively. The cumulative incidence of HCC was lower in HBV-ACLF cohort with 369 eligible patients survived for >90 days than in HBV-CLD cohort with the 380 patients (5.77/1,000 vs. 9.78/1,000 person-years, p = 0.0497). HBV-ACLF episode decreased HCC risk regardless of liver cirrhosis, and in patients without family history of HCC. Multivariate Cox analyses indicated that male, increasing age, liver cirrhosis, and platelet count (≤100 × 109/L) increased, whereas HBV-ACLF episode decreased, HCC risk independently. In the propensity score-matched cohorts, HBV-ACLF episode reduced HCC incidence (10.20/1,000 vs. 4.66/1,000 person-years, p = 0.0326). The area under curve of nomogram was 0.812 for 3-year HCC probability.
Conclusions:
HBV-ACLF episode decreases HCC occurrence in chronic HBV patients. Older age and liver cirrhosis independently increased HCC occurrence. A nomogram-enrolled episode of ACLF reliably predicts the occurrence of HCC.
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