Virological suppression and hepatocellular carcinoma risk in chronic Hep B patients with cirrhosis

Virological suppression and hepatocellular carcinoma risk in chronic Hep B patients with cirrhosis

Virological suppression does not prevent hepatocellular carcinoma in Hepatitis B e antigen-negative chronic Hepatitis B patients with cirrhosis receiving oral antiviral starting with lamivudine monotherapy, reports August's issue of Gut.

Professor George Papatheodoridis and colleagues from California, USA evaluated the risk and predictors of hepatocellular carcinoma in Hepatitis B e antigen-negative chronic hepatitis B patients of the large HEPNET Greece cohort study who received long-term oral antivirals starting with lamivudine monotherapy.

The team performed a retrospective analysis of hepatocellular carcinoma incidence in HBeAg-negative chronic hepatitis B patients from a retrospective–prospective cohort who were treated with nucleotide analogues starting with lamivudine monotherapy for 12 months or more.

The team included 818 patients, of which 517 had chronic hepatitis B only, 160 with compensated cirrhosis, 56 with decompensated cirrhosis, and 85 had unclassified disease severity.

All patients were treated with nucleotide analogue starting with lamivudine monotherapy.
Hepatocellular carcinoma developed in 7% of 50–60 years old
Gut

The team's main outcome measures included development of hepatocellular carcinoma.

During a median follow-up of 5 years, hepatocellular carcinoma developed in 6% of patients.

The research team found that the 5-year cumulative incidence of hepatocellular carcinoma was higher in patients with cirrhosis than in those with chronic hepatitis B only.

The researchers observed that hepatocellular carcinoma developed in 0.7%, 7% and 12% of patients that were less than 50, 50–60 and over 60 years old, respectively.

The team noted that virological on-therapy remission did not significantly affect the incidence of hepatocellular carcinoma in all patients or those with cirrhosis, but it showed a trend for lower hepatocellular carcinoma incidence in patients with chronic hepatitis B only.

In multivariate analysis, age, gender and cirrhosis were independently associated with hepatocellular carcinoma risk regardless of virological remission.

Professor Papatheodoridis' team commented, "Long-term therapy with nucleotide analogues starting with lamivudine monotherapy does not eliminate HCC risk in Hepatitis B e antigen-negative chronic hepatitis B."

"The risk of hepatocellular carcinoma is particularly high in patients with cirrhosis, who should remain under hepatocellular carcinoma surveillance even during effective therapy."

"Older age and male gender remain independent risk factors for hepatocellular carcinoma, while virological on-therapy remission does not seem to significantly reduce the overall incidence of

Gut 2011; 60: 1109-1116
14 July 2011