Progression Rates by Age, Sex, Treatment, and Disease Activity by AASLD and EASL Criteria: Data for Precision Medicine

doi:10.1016/j.cgh.2021.05.062

. 2022 Apr;20(4):874-885.e4.

doi: 10.1016/j.cgh.2021.05.062. Epub 2021 Jun 2.

Progression Rates by Age, Sex, Treatment, and Disease Activity by AASLD and EASL Criteria: Data for Precision Medicine

Jiyoon Park¹, An K Le², Tai-Chung Tseng³, Ming-Lun Yeh⁴, Dae Won Jun⁵, Huy Trinh⁶, Grace L H Wong⁷, Chien-Hung Chen⁸, Cheng-Yuan Peng⁹, Sung Eun Kim¹⁰, Hyunwoo Oh¹¹, Min-Sun Kwak¹¹, Ka Shing Cheung¹², Hidenori Toyoda¹³, Yao-Chun Hsu¹⁴, Jae Yoon Jeong¹⁵, Eileen L Yoon⁵, Teerapat Ungtrakul¹⁶, Jian Zhang¹⁷, Qing Xie¹⁸, Sang Bong Ahn¹⁹, Masaru Enomoto²⁰, Jae-Jun Shim²¹, Chris Cunningham²², Soung Won Jeong²³, Yong Kyun Cho²⁴, Eiichi Ogawa²⁵, Rui Huang²⁶, Dong-Hyun Lee²⁷, Hirokazu Takahashi²⁸, Pei-Chien Tsai⁴, Chung-Feng Huang⁴, Chia-Yen Dai⁴, Cheng-Hao Tseng¹⁴, Satoshi Yasuda¹³, Ritsuzo Kozuka²⁰, Jiayi Li²⁹, Christopher Wong³⁰, Clifford C Wong³¹, Changqing Zhao³², Joseph Hoang², Yuichiro Eguchi²⁸, Chao Wu²⁶, Yasuhito Tanaka³³, Ed Gane³⁴, Tawesak Tanwandee³⁵, Ramsey Cheung², Man-Fung Yuen¹², Hyo-Suk Lee¹¹, Ming-Lung Yu⁴, Jia-Horng Kao³, Hwai-I Yang³⁶, Mindie H Nguyen³⁷

Affiliations

¹ Department of Medicine, Santa Clara Valley Medical Center, Santa Clara, California; Division of Gastroenterology and Hepatology, Stanford University Medical Center, California.
² Division of Gastroenterology and Hepatology, Stanford University Medical Center, California.
³ Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Department of Gastroenterology, Hanyang University College of Medicine, Seoul, Republic of Korea.
⁶ San Jose Gastroenterology, San Jose, California.
⁷ Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR, China.
⁸ Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
⁹ Department of Gastroenterology, China Medical University Hospital, Taichung, Taiwan.
¹⁰ Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
¹¹ Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
¹² Department of Medicine, the University of Hong Kong, Hong Kong SAR, China.
¹³ Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
¹⁴ Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
¹⁵ Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea.
¹⁶ Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
¹⁷ Chinese Hospital, San Francisco, California.
¹⁸ Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹⁹ Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea.
²⁰ Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
²¹ Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
²² Research Centre for Maori Health and Development, Massey University, Wellington, New Zealand.
²³ Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
²⁴ Department of Internal Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
²⁵ Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
²⁶ Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
²⁷ Department of Gastroenterology, Good Gang-An Hospital, Busan, Republic of Korea.
²⁸ Department of Internal Medicine, Saga University Hospital, Saga, Japan.
²⁹ Palo Alto Medical Foundation, Mountain View Division, Mountain View, California.
³⁰ Wong Clinics, San Francisco, California.
³¹ Wong Clinics, San Francisco, California; Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
³² Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
³³ Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
³⁴ New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
³⁵ Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
³⁶ Genomics Research Center, Academia Sinica, Taipei, Taiwan.
³⁷ Division of Gastroenterology and Hepatology, Stanford University Medical Center, California; Department of Epidemiology and Population Health, Stanford University, Stanford, California. Electronic address: mindiehn@stanford.edu.

PMID: 34089852
DOI: 10.1016/j.cgh.2021.05.062

Progression Rates by Age, Sex, Treatment, and Disease Activity by AASLD and EASL Criteria: Data for Precision Medicine

Jiyoon Park et al. Clin Gastroenterol Hepatol. 2022 Apr.

. 2022 Apr;20(4):874-885.e4.

doi: 10.1016/j.cgh.2021.05.062. Epub 2021 Jun 2.

Authors

Affiliations

¹ Department of Medicine, Santa Clara Valley Medical Center, Santa Clara, California; Division of Gastroenterology and Hepatology, Stanford University Medical Center, California.
² Division of Gastroenterology and Hepatology, Stanford University Medical Center, California.
³ Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Department of Gastroenterology, Hanyang University College of Medicine, Seoul, Republic of Korea.
⁶ San Jose Gastroenterology, San Jose, California.
⁷ Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR, China.
⁸ Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
⁹ Department of Gastroenterology, China Medical University Hospital, Taichung, Taiwan.
¹⁰ Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
¹¹ Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
¹² Department of Medicine, the University of Hong Kong, Hong Kong SAR, China.
¹³ Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
¹⁴ Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
¹⁵ Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea.
¹⁶ Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
¹⁷ Chinese Hospital, San Francisco, California.
¹⁸ Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹⁹ Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea.
²⁰ Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
²¹ Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
²² Research Centre for Maori Health and Development, Massey University, Wellington, New Zealand.
²³ Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
²⁴ Department of Internal Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
²⁵ Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
²⁶ Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
²⁷ Department of Gastroenterology, Good Gang-An Hospital, Busan, Republic of Korea.
²⁸ Department of Internal Medicine, Saga University Hospital, Saga, Japan.
²⁹ Palo Alto Medical Foundation, Mountain View Division, Mountain View, California.
³⁰ Wong Clinics, San Francisco, California.
³¹ Wong Clinics, San Francisco, California; Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
³² Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
³³ Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
³⁴ New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
³⁵ Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
³⁶ Genomics Research Center, Academia Sinica, Taipei, Taiwan.
³⁷ Division of Gastroenterology and Hepatology, Stanford University Medical Center, California; Department of Epidemiology and Population Health, Stanford University, Stanford, California. Electronic address: mindiehn@stanford.edu.

PMID: 34089852
DOI: 10.1016/j.cgh.2021.05.062

Abstract

Background & aims: Antiviral treatment criteria are based on disease progression risk, and hepatocellular carcinoma (HCC) surveillance recommendations for patients with chronic hepatitis B (CHB) without cirrhosis is based on an annual incidence threshold of 0.2%. However, accurate and precise disease progression estimate data are limited. Thus, we aimed to determine rates of cirrhosis and HCC development stratified by age, sex, treatment status, and disease activity based on the 2018 American Association for the Study of Liver Diseases and 2017 European Association for the Study of the Liver guidelines.

Methods: We analyzed 18,338 patients (8914 treated, 9424 untreated) from 6 centers from the United States and 27 centers from Asia-Pacific countries. The Kaplan-Meier method was used to estimate annual progression rates to cirrhosis or HCC in person-years.

Results: The cohort was 63% male, with a mean age of 46.19 years, with baseline cirrhosis of 14.3% and median follow up of 9.60 years. By American Association for the Study of Liver Diseases criteria, depending on age, sex, and disease activity, annual incidence rates ranged from 0.07% to 3.94% for cirrhosis, from 0.04% to 2.19% for HCC in patients without cirrhosis, and from 0.40% to 8.83% for HCC in patients with cirrhosis. Several subgroups of patients without cirrhosis including males younger than 40 years of age and females younger than 50 years of age had annual HCC risk near or exceeding 0.2%. Similar results were found using European Association for the Study of the Liver criteria.

Conclusion: There is great variability in CHB disease progression rates even among "lower-risk" populations. Future CHB modeling studies, public health planning, and HCC surveillance recommendation should be based on more precise disease progression rates based on sex, age, and disease activity, plus treatment status.

Keywords: Antiviral Therapy; Epidemiology; Inactive Patients; Natural History; Untreated patients.

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Progression Rates by Age, Sex, Treatment, and Disease Activity by AASLD and EASL Criteria: Data for Precision Medicine

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Progression Rates by Age, Sex, Treatment, and Disease Activity by AASLD and EASL Criteria: Data for Precision Medicine

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