Patients who recovered from HBV infection still at risk for liver cancer
Results of a study conducted by the Chinese University of Hong Kong (CUHK) revealed that patients who recovered from hepatitis B virus (HBV) infection are still at risk for hepatocellular carcinoma (HCC).
The recently published retrospective cohort study was conducted using data from the Clinical Data Analysis and Reporting System (CDARS) of the Hong Kong Hospital Authority (HA) and included 4,568 patients who experienced hepatitis B surface antigen (HBsAg) seroclearance. [J Hepatol 2017;67:902-908]
After a median follow-up period of 3.4 years from January 2000 to August 2016, 54 patients (1 percent) developed HCC. The cumulative incidence of HCC was 0.9 percent after 1 year, 1.3 percent after 3 years and 1.5 percent after 5 years.
The study also demonstrated that female patients aged above 50 years (adjusted hazard ratio [HR], 4.31; p=0.002) and all male patients (HR, 2.47; p=0.01) were still at risk for HCC after recovery from HBV infection.
The 5-year cumulative incidence of HCC was higher among male and female patients above 50 years of age vs female patients younger than 50 years of age (2.5 percent and 1.0 percent vs 0.7 percent).
“The reason for the increased HCC risk is the liver damage brought about by inflammatory processes such as cirrhosis, HBV genome integration into host liver cell chromosomes, and environmental factors such as fatty liver that took place prior to seroconversion,” explained investigator Professor Henry Chan of the Center for Liver Health, Faculty of Medicine, CUHK.
“Results of the study highlight that HCC surveillance is needed even after hepatitis B recovery, which is in line with international recommendations. In patients who have recovered from HBV infection, HCC surveillance is cost-effective if the annual risk is greater than 0.2 percent,” investigator Professor Grace Wong of the Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, CUHK, added. [J Hepatol 2017;67:902-908]
Limitations of the study include failure to identify patients with cirrhosis in the analysis and unavailability of the HBV genotype of the patients.
Researchers from the CUHK Center for Liver Health also developed a simple, easy-to-use, web-based Hepatocellular Carcinoma Score Online Calculator, which allows individuals with chronic HBV infection to predict their future risk for HCC according to risk factors such as age, HBV DNA level, albumin and bilirubin levels and the presence of cirrhosis. [http://www.livercenter.com.hk/]
“The scoring system we developed is based on international and multicentre studies, and could also be applicable to other ethnic groups outside of Hong Kong,” said Wong.
The investigators also recently reported that recovery from HBV infection is not very common but increases with age (probability of HBV recovery at 40 years, 1 percent; 50 years, 2.5 percent; 50 years, 6.9 percent; 70 years, 13.9 percent). [Yip TC, et al, J Hepatol, in press]
Previous studies have reported that the age at seroclearance, hepatitis C and hepatitis D co-infection, and presence of cirrhosis are important risk factors for HCC despite HBsAg seroclearance. [Gut 2014;63:1648-1657; Gastroenterology 2002;123:1084-1089; Gut 2014; 63:1325-1332]