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. 2023 Nov;39(11):1145-1154.
doi: 10.1002/kjm2.12744. Epub 2023 Sep 2.

Unawareness of hepatitis B infection and lack of surveillance are associated with severity of hepatocellular carcinoma

Kuan-I Lee  1 , Po-Cheng Liang  2 , Po-Yau Hsu  1   2 , Tyng-Yuan Jang  1   2 , Yu-Ju Wei  2 , Ching-I Huang  1   2 , Ming-Yen Hsieh  2 , Zu-Yau Lin  1   2 , Ming-Lun Yeh  1   2 , Chung-Feng Huang  1   2 , Jee-Fu Huang  1   2 , Chia-Yen Dai  1   2 , Wan-Long Chuang  1   2 , Ming-Lung Yu  1   2   3
Affiliations

Unawareness of hepatitis B infection and lack of surveillance are associated with severity of hepatocellular carcinoma

Kuan-I Lee et al. Kaohsiung J Med Sci. 2023 Nov.

Abstract

Unawareness of hepatitis B virus (HBV) infection and lack of surveillance may serve as major barriers to HBV control and contributors to severe hepatocellular carcinoma (HCC) at presentation. This study evaluated the risk of HBV unawareness and its relationship with HCC severity. This retrospective study was conducted in a tertiary hospital in Taiwan. Patients with HBV-related HCC diagnosed from 2011 to 2021 were enrolled. The demographic, clinical, and HCC characteristics were collected and compared between patients with HBV unawareness and awareness with and without surveillance. Of 501 HBV-related HCC patients enrolled, 105 (21%) patients were unaware of HBV infection at the time of HCC diagnosis. Patients with HBV unawareness were significantly younger and had poorer liver function than those with HBV awareness. Patients with HBV unawareness also had a significantly higher rate of detectable HBV DNA and an advanced stage of HCC. Ninety-one (23%) of the HBV-aware patients did not receive regular surveillance. Patients with HBV unawareness and awareness without surveillance shared similar clinical characteristics with more severe HCC status. Further regression analysis demonstrated that HBV awareness with periodic surveillance was associated with early stage HCC. Meanwhile, we observed that there was no change in the proportion of HBV awareness over the past 10 years. Patients with surveillance also had better HCC survival than patients without surveillance or unawareness. HBV unawareness and lack of regular surveillance correlated with advanced HCC at presentation. Efforts to improve HBV education, disease awareness, and HCC surveillance are needed.

Keywords: HBV; HCC; disease awareness; surveillance program; tumor staging.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study allocation flowchart.
FIGURE 2
FIGURE 2
Proportions of HBV‐related HCC patients who were HBV unaware, aware with and without regular surveillance by year of diagnosis. HBV, hepatitis B virus; HCC, hepatocellular carcinoma.
FIGURE 3
FIGURE 3
HCC survival between patients with HBV awareness and unawareness (A) and patients with HBV awareness with and without regular surveillance and unawareness (B). HBV, hepatitis B virus; HCC, hepatocellular carcinoma.
See this image and copyright information in PMC

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