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Meta-Analysis
. 2021 Apr;28(4):601-612.
doi: 10.1111/jvh.13471. Epub 2021 Feb 8.

Durability of hepatitis B surface antigen seroclearance and subsequent risk for hepatocellular carcinoma: A meta-analysis

Aixin Song  1 , Xiaoxiao Wang  1 , Junfeng Lu  1 , Yi Jin  1 , Lina Ma  1 , Zhongjie Hu  1 , Yanhong Zheng  1 , Chengli Shen  2 , Xinyue Chen  1
Affiliations
Meta-Analysis

Durability of hepatitis B surface antigen seroclearance and subsequent risk for hepatocellular carcinoma: A meta-analysis

Aixin Song et al. J Viral Hepat. 2021 Apr.

Abstract

Hepatitis B surface antigen (HBsAg) seroclearance is regarded as the ideal endpoint for antiviral treatment. However, reports on the durability of and outcomes after HBsAg seroclearance are few, which has become a focus in clinical practice. This meta-analysis was performed to evaluate the durability and hepatocellular carcinoma (HCC) incidence after HBsAg seroclearance after treatment cessation. We searched PubMed, Embase, Medline and Web of Science for studies that reported the durability and HCC incidence after HBsAg seroclearance published between 1 January 2000 and 31 January 2020. Data were analysed by a random-effects model. Thirty-eight studies and 43,924 patients were finally included. The results showed that HBsAg seroclearance was durable, with a pooled recurrence rate of 6.19% (95% CI: 4.10%-8.68%). There was no significant difference in recurrence rates after different seroclearance methods or among recurrence types and different regions. Anti-HBs seroconversion resulted in a significantly reduced recurrence rate (RR = 0.25, p < .001). Patients who experienced HBsAg seroclearance had significantly lower HCC incidence than HBsAg-positive (RR = 0.41, p < .001). The pooled HCC incidence after HBsAg seroclearance was 1.88%; this rate was reduced to 0.76% among patients without baseline cirrhosis. In conclusion, the analysis during an average follow-up of 4.74 years suggested that in patients who experienced sustained HBsAg seroclearance and anti-HBs seroconversion, this was associated with low HCC incidence. Patients without baseline cirrhosis benefited even more. We emphasize the importance of gaining HBsAg seroclearance while highlighting the benefits of achieving this as early as possible.

Keywords: HBV; HBsAg; HCC; meta-analysis; recurrence rate.

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Conflict of interest statement

All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study selection process
FIGURE 2
FIGURE 2
Meta‐analysis of overall pooled recurrence rate in CHB patients after HBsAg seroclearance
FIGURE 3
FIGURE 3
Meta‐analysis of recurrence rate after HBsAg seroclearance among anti‐HBs‐positive or anti‐HBs‐negative patients
FIGURE 4
FIGURE 4
Meta‐analysis of HCC incidence among CHB patients with HBsAg seroclearance male or HBsAg‐positive
FIGURE 5
FIGURE 5
Meta‐analysis of overall pooled HCC incidence in CHB patients after HBsAg seroclearance
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