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Distinct on-treatment HCC risks associated with different decompensation events in HBV patients with cirrhosis

Yuanyuan Kong1,2, Yameng Sun3, Xiaoning Wu3

  • 1Clinical Epidemiology & EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China.

Hepatology International
|August 19, 2023
PubMed

Insights

Nucleoside analog (NA) treatment for chronic hepatitis B (CHB) patients with compensated cirrhosis (CC) shows a higher risk of hepatocellular carcinoma (HCC) than decompensation. Specific decompensation events significantly influence the subsequent risk of developing HCC.

Area of Science:

  • Hepatology
  • Virology
  • Oncology

Background:

  • Long-term nucleoside analog (NA) therapy is known to reduce risks of decompensation and hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients with compensated cirrhosis (CC).
  • However, the differential impact of antiviral therapy on the specific risks for decompensation versus HCC requires further elucidation.
  • Understanding disease state transitions is crucial for optimizing treatment strategies in CHB patients with CC.

Purpose of the Study:

  • To investigate disease state transitions in NA-treated CHB patients with CC.
  • To specifically analyze the risk of HCC development following different decompensation events.
  • To provide insights into HCC risk stratification in this patient population.

Main Methods:

  • Prospective follow-up of 1163 NA-treated CHB patients with CC for up to seven years.
  • Kaplan-Meier analysis and competing risk models to assess cumulative incidence and risk of HCC.
  • Multistate models to estimate transition probabilities to HCC from various disease states.

Main Results:

  • Hepatocellular carcinoma (HCC) was the predominant first liver-related event, with a 5-year cumulative incidence of 9.0%.
  • Decompensation occurred with a 5-year cumulative incidence of 8.3%, with nonbleeding decompensation being more frequent than variceal bleeding.
  • The decompensation stage exhibited a significantly higher 5-year cumulative HCC incidence (27.6%) compared to the compensated cirrhosis (CC) stage (9.1%). Nonbleeding decompensation events showed a higher transition probability to HCC than bleeding events.
  • Viral suppression was associated with a reduced on-treatment transition risk to HCC.

Conclusions:

  • In NA-treated CHB patients with CC, the risk of HCC development is higher than that of decompensation.
  • Different types of decompensation events confer distinct risks for subsequent HCC development.
  • These findings highlight the importance of monitoring for HCC, especially after specific decompensation events, in NA-treated CHB patients with CC.
Abstract

Keywords:
Antiviral treatmentChronic hepatitis BCirrhosisHepatocellular carcinomaMultistate model

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