Risk Factors and Nomogram Model for Hepatocellular Carcinoma Development in Chronic Hepatitis B Patients with...

Area of Science:

• Hepatology and Viral Hepatitis Research
• Oncology and Cancer Risk Prediction
• Clinical Epidemiology and Cohort Studies

Background:

• Chronic hepatitis B (CHB) patients with low-level viremia (LLV) are not risk-free for hepatocellular carcinoma (HCC).
• The optimal antiviral treatment strategy for CHB patients with LLV remains debated.
• Accurate risk stratification is crucial for managing CHB patients with LLV.

Purpose of the Study:

• To investigate the risk of HCC development in CHB patients with LLV.
• To identify independent risk factors for HCC in CHB patients with LLV.
• To develop and validate a nomogram model for predicting HCC risk in this population.

Main Methods:

• Retrospective cohort study of 16,895 CHB patients (January 2008 - December 2020).
• Comparison of HCC incidence across three groups: LLV, maintained virological response (MVR), and HBV-DNA > 2000 IU/mL.
• Cox regression analysis for risk factor identification and nomogram construction; 10-fold cross-validation for internal validation.

Main Results:

• 408 new HCC cases occurred over a mean follow-up of 5.78 years.
• Cumulative HCC risks at 3, 5, and 10 years in the LLV group were 3.56%, 4.96%, and 9.51%.
• Independent HCC risk factors in the LLV group included male gender, age, cirrhosis, and platelet count; AUCs for 3- and 5-year predictions were 0.75 and 0.76.

Conclusions:

• CHB patients with LLV and MVR remain at significant risk of developing HCC.
• The developed nomogram effectively predicts HCC-free outcomes in CHB patients with LLV.
• This nomogram provides valuable data for optimizing surveillance and antiviral therapy decisions.