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Long-Term Incidence of Hepatocellular Carcinoma After Hepatitis B Surface Antigen Seroclearance
Soleiman El-Debeiky1, Tony Hiu-Fung Lam2, Mandy Sze-Man Lai3
1Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Insights
Hepatitis B surface antigen (HBsAg) seroclearance significantly lowers hepatocellular carcinoma (HCC) risk. Patients clearing HBsAg before age 50 without cirrhosis have HCC incidence comparable to the general population.
Area of Science:
- Hepatology
- Oncology
- Virology
Background:
- Hepatitis B virus (HBV) infection is a leading cause of chronic hepatitis B (CHB).
- Hepatocellular carcinoma (HCC) is a major complication of CHB.
- Hepatitis B surface antigen (HBsAg) seroclearance is associated with reduced HCC risk.
Purpose of the Study:
- To evaluate HCC incidence in patients with CHB after HBsAg seroclearance.
- To compare HCC risk in this cohort with the general population.
Main Methods:
- Retrospective analysis of a territory-wide Hong Kong database (2000-2022).
- Inclusion of adult patients with CHB who achieved HBsAg seroclearance.
- Comparison of age- and sex-specific HCC incidence with general population data.
Main Results:
- Among 13,379 patients with HBsAg seroclearance, 2.0% developed HCC.
- Patients clearing HBsAg before age 50 without cirrhosis showed HCC incidence (0.03%) similar to the general population.
- Male patients <40 years and female patients <50 years without cirrhosis had very low annual HCC incidence.
Conclusions:
- HBsAg seroclearance substantially reduces HCC risk in CHB patients.
- Younger patients (men <40, women <50) without cirrhosis or other risk factors have a very low HCC risk post-seroclearance.
- Routine HCC surveillance may not be necessary for select low-risk individuals after HBsAg seroclearance.
Background & Aims:
The risk of hepatocellular carcinoma (HCC) decreases after hepatitis B surface antigen (HBsAg) seroclearance. We examined HCC incidence in patients with chronic hepatitis B (CHB) who cleared HBsAg compared with the general population.
Methods:
All adults with CHB who cleared HBsAg between 2000 and 2022 were identified using a territory-wide database in Hong Kong. Annual HCC incidences were estimated and compared with the general population. Age- and sex-specific population statistics were retrieved from the Hong Kong Cancer Registry and Census and Statistics Department.
Results:
Of 13,379 patients with HBsAg seroclearance (mean age, 59.7 ± 13.7 years; 59.8% men, 14.6% cirrhosis), HCC developed in 274 (2.0%) at a median of 5.6 years (25th-75th percentile, 3.1-9.8 years). Annual HCC incidence was 0.43% (95% confidence interval [CI], 0.22%-0.73%) and 0.62% (95% CI, 0.50%-0.76%) among patients with cirrhosis aged <50 years and ≥50 years at HBsAg seroclearance, respectively. In patients without cirrhosis who cleared HBsAg before age 50, the annual HCC incidence was 0.03% (95% CI, 0.01%-0.06%), comparable to 0.03% in general population. Annual HCC incidence of male patients without cirrhosis aged <40 and 40 to 49 years at HBsAg was 0.02% (95% CI, 0.002%-0.08%) and 0.09% (95% CI, 0.03%-0.19%), respectively. No HCC cases occurred during 15 years/ of follow-up among 1317 female patients without cirrhosis aged <50 years at HBsAg loss; the annual HCC incidence was 0.06% (95% CI, 0.02%-0.13%) among those aged 50 to 59 years.
Conclusions:
Patients with CHB who clear HBsAg at younger ages, particularly men <40 years and women <50 years without cirrhosis or additional risk factors, have very low HCC risk and may not require routine surveillance.
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