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. 2022 Aug 28;12(9):2085.
doi: 10.3390/diagnostics12092085.

Older Age and High α-Fetoprotein Predict Higher Risk of Hepatocellular Carcinoma in Chronic Hepatitis-B-Related Cirrhotic Patients Receiving Long-Term Nucleos(t)ide Analogue Therapy

Yuh-Ying Liu  1 , Chih-Lang Lin  1   2 , Cheng-Hao Weng  2   3 , Pei-Hung Chang  2   4 , Cheng-Hung Chien  1 , Kuang-Chen Huang  1 , Man-Chin Hua  2   5 , Ching-Chih Hu  1   2
Affiliations

Older Age and High α-Fetoprotein Predict Higher Risk of Hepatocellular Carcinoma in Chronic Hepatitis-B-Related Cirrhotic Patients Receiving Long-Term Nucleos(t)ide Analogue Therapy

Yuh-Ying Liu et al. Diagnostics (Basel). .

Abstract

Background: Nucleos(t)ide analogues (NUCs) were proved to reduce hepatocellular carcinoma (HCC) development in chronic hepatitis B (CHB) patients, but data were limited on their efficacy in cirrhotic CHB patients. Methods: A total of 447 cirrhotic CHB patients treated with tenofovir/entecavir were retrospectively analyzed and divided into HCC (n = 48) and non-HCC (n = 399) groups. The median follow-up period was 62.1 months. Results: A total of 48 patients (10.7%) developed HCC during surveillance. The annual incidence rate of HCC was 2.04 per 100 person-years. The cumulative incidence of HCC was 0.9%, 9.8%, and 22.1% at 1, 5, and 10 years, respectively. Significant predictors for HCC identified using a multiple Cox regression analysis were age ≥50 years (hazard ratio (HR): 2.34) and α-fetoprotein (AFP) ≥8 ng/mL (HR: 2.05). The incidence rate of HCC was 8.67-fold higher in patients with age ≥50 years and AFP ≥8 ng/mL (3.14 per 100 person-years) than those with age <50 years and AFP <8 ng/mL (0.36 per 100 person-years). Conclusions: Cirrhotic CHB patients with age <50 years and AFP <8 ng/mL had the lowest annual incidence of HCC. However, those with age ≥50 years or/and AFP ≥8 ng/mL had a significantly higher risk for HCC development and warrant a careful surveillance schedule.

Keywords: chronic hepatitis B; cirrhosis; cumulative incidence; entecavir; hepatocellular carcinoma; incidence rate; risk; tenofovir.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cumulative incidence of hepatocellular carcinoma assessed using baseline risk factors: (a) age; (b) albumin; (c) HBV DNA; (d) AFP; (e) NUCs. Patients with older age, higher AFP and HBV DNA levels, and low albumin levels had a higher risk for HCC development during NUC therapy. The risk of HCC development was not different between the two NUCs. AFP, α-fetoprotein; NUC, nucleos(t)ide analogue; TDF, tenofovir; ETV, entecavir.
Figure 1
Figure 1
Cumulative incidence of hepatocellular carcinoma assessed using baseline risk factors: (a) age; (b) albumin; (c) HBV DNA; (d) AFP; (e) NUCs. Patients with older age, higher AFP and HBV DNA levels, and low albumin levels had a higher risk for HCC development during NUC therapy. The risk of HCC development was not different between the two NUCs. AFP, α-fetoprotein; NUC, nucleos(t)ide analogue; TDF, tenofovir; ETV, entecavir.
Figure 2
Figure 2
Cumulative incidence of hepatocellular carcinoma according to age and AFP.
Figure 3
Figure 3
Cumulative incidence of hepatocellular carcinoma according to age and HBV DNA.
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