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Multicenter Study
. 2021 Jan 11;12(1):e00290.
doi: 10.14309/ctg.0000000000000290.

Risk and Risk Score Performance of Hepatocellular Carcinoma Development in Patients With Hepatitis B Surface Antigen Seroclearance

Yewan Park  1 , Jeong-Hoon Lee  2 , Dong Hyun Sinn  1 , Jun Yong Park  3 , Minseok Albert Kim  2 , Yoon Jun Kim  2 , Jung-Hwan Yoon  2 , Do Young Kim  3 , Sang Hoon Ahn  3 , Wonseok Kang  1 , Geum-Youn Gwak  1 , Yong-Han Paik  1 , Moon Seok Choi  1 , Joon Hyeok Lee  1 , Kwang Cheol Koh  1 , Seung Woon Paik  1
Affiliations
Multicenter Study

Risk and Risk Score Performance of Hepatocellular Carcinoma Development in Patients With Hepatitis B Surface Antigen Seroclearance

Yewan Park et al. Clin Transl Gastroenterol. .

Abstract

Introduction: Hepatocellular carcinoma (HCC) can develop among chronic hepatitis B patients after hepatitis B surface antigen (HBsAg) seroclearance. However, whether HCC risk after HBsAg seroclearance differs between antiviral therapy (AVT)-induced or spontaneous seroclearance cases and ways to identify at-risk populations remain unclear.

Methods: A retrospective cohort of 1,200 adult chronic hepatitis B patients who achieved HBsAg seroclearance (median age: 56 years; 824 men; 165 with cirrhosis; 216 AVT-induced cases) were analyzed. The risk of HCC after HBsAg seroclearance and the performance of 6 HCC prediction models were assessed.

Results: During a median of 4.8 years of follow-up (range: 0.5-17.8 years), HCC developed in 23 patients (1.9%). The HCC incidence rate was higher in the AVT-induced cases than that in the spontaneous cases (3.9% vs 0.9% at 5 years). AVT and cirrhosis were independent factors associated with HCC, with HCC incidence rates of 0.5%, 1.2%, 4.0%, and 10.5% at 5 years for spontaneous/no-cirrhosis, AVT-induced/no-cirrhosis, spontaneous/cirrhosis, and AVT-induced/cirrhosis patients, respectively. Among the 6 predictive HCC models tested, Chinese University-HCC score (0.82) showed the highest C-statistics, which was followed by guide with age, gender, HBV DNA, core promoter mutations and cirrhosis (0.81).

Discussion: AVT-induced HBsAg seroclearance was associated with higher HCC risk, especially for patients with cirrhosis, indicating that they need careful monitoring for HCC risk. The HCC risk models were able to stratify the HCC risk in patients with HBsAg seroclearance.

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Conflict of interest statement

Guarantor of the article: Dong Hyun Sinn, MD, PhD.

Specific author contributions: Yewan Park, MD, and Jeong-Hoon Lee, MD, PhD, contributed equally to this study. J.-H.L., D.H.S., and J.Y.P.: study design. Y.P. and D.H.S.: drafting of the manuscript. Y.P., J.Y.P., J.-H.L., M.A.K., Y.J.K., J.-H.Y., S.H.A., W.K., G.-Y.G., Y.-H.P., M.S.C., J.H.L., K.C.K., and S.W.P.: data collection. Y.P., D.H.S., and J.H.L.: statistical analysis and interpretation of the data. J.Y.P., J.-H.L., Y.J.K., J.-H.Y., S.H.A., G.-Y.G., Y.-H.P., M.S.C., J.H.L., K.C.K., and S.W.P.: critical revision of the manuscript. D.H.S. and J.Y.P.: study supervision. All authors approved the final submission.

Financial support: None to report.

Potential competing interests: None to report.

Figures

Figure 1.
Figure 1.
Study participants. A total of 1,200 patients were analyzed in this study. CHB, chronic hepatitis B; HBsAg, hepatitis B surface antigen; HCC, hepatocellular carcinoma; HCV, hepatitis C virus.
Figure 2.
Figure 2.
Cumulative incidence of hepatocellular carcinoma according to cirrhosis and antiviral treatment. AVT, antiviral therapy; HCC, hepatocellular carcinoma; LC, liver cirrhosis.
See this image and copyright information in PMC

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