Predicting Hepatocellular Carcinoma Risk in Chronic Hepatitis B Patients Receiving Finite Periods of Antiviral Therapy
PURPOSE: Hepatocellular carcinoma (HCC) is one of the most severe complications in chronic hepatitis B virus (HBV) infection. HCC can still develop in patients with chronic HBV (CHB) infection undergoing antiviral therapy. Several effective scoring systems for the prediction of HCC risk in CHB patie...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-06-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/13/3343 |
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| author | Chih-Lang Lin Szu-Yuan Wu Ming-Wei Lai Chao-Wei Hsu Wan-Ming Chen An-Tzu Jao Cheng-Hung Chien Ching-Chih Hu Rong-Nan Chien Chau-Ting Yeh |
| author_facet | Chih-Lang Lin Szu-Yuan Wu Ming-Wei Lai Chao-Wei Hsu Wan-Ming Chen An-Tzu Jao Cheng-Hung Chien Ching-Chih Hu Rong-Nan Chien Chau-Ting Yeh |
| author_sort | Chih-Lang Lin |
| collection | DOAJ |
| description | PURPOSE: Hepatocellular carcinoma (HCC) is one of the most severe complications in chronic hepatitis B virus (HBV) infection. HCC can still develop in patients with chronic HBV (CHB) infection undergoing antiviral therapy. Several effective scoring systems for the prediction of HCC risk in CHB patients have been established. However, very few of them are designed for CHB patients receiving nucleos(t)ide analogues (NAs) therapy. Furthermore, none are available for HCC risk prediction in CHB patients receiving finite periods of antiviral therapy. METHODS: This study enrolled 790 consecutive treatment-naïve patients with CHB infection who had visited our liver clinics from 2008 to 2012 for pretreatment assessment before receiving antiviral therapies. The treatments were provided at finite periods according to the National Health Insurance Policy in Taiwan. The last follow-up date was 31 December 2021. We analyzed the virological and clinical factors in these 790 CHB patients receiving finite periods of NA treatments and identified the most significant risk factors for HCC to establish a novel predictive scoring system. By using stepwise selection in a multivariate Cox proportional hazards model, we divided the patients into three risk groups. RESULTS: Our predictive scoring system included five independent variables: genotype C (adjusted HR [aHR] = 2.23), NA-withdraw-related hepatitis relapse (aHR = 6.96), male (aHR = 4.19), liver cirrhosis (aHR = 11.14), and T1768A core promoter mutation (aHR = 3.21). This model revealed significant differences in HCC incidence among the three risk groups. The 5-year cumulative HCC risk significantly differed among the three risk groups (low risk: 1.33%, moderate risk: 4.99%, and high risk: 17.46%), with log-rank test <i>p</i> < 0.001. CONCLUSION: Our predictive scoring system is a promising tool for the prediction of HCC in CHB patients receiving finite NA treatments. Genotype C, NA-withdraw-related hepatitis relapse, male gender, liver cirrhosis, and the T1768A HBV core promoter mutation were significant independent risk factors. |
| first_indexed | 2024-03-11T01:45:46Z |
| format | Article |
| id | doaj.art-104bc60ce89e40e18d61224b9c663148 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T01:45:46Z |
| publishDate | 2023-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-104bc60ce89e40e18d61224b9c6631482023-11-18T16:15:38ZengMDPI AGCancers2072-66942023-06-011513334310.3390/cancers15133343Predicting Hepatocellular Carcinoma Risk in Chronic Hepatitis B Patients Receiving Finite Periods of Antiviral TherapyChih-Lang Lin0Szu-Yuan Wu1Ming-Wei Lai2Chao-Wei Hsu3Wan-Ming Chen4An-Tzu Jao5Cheng-Hung Chien6Ching-Chih Hu7Rong-Nan Chien8Chau-Ting Yeh9Liver Research Center, Department of Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, Keelung 204, TaiwanGraduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 242, TaiwanCollege of Medicine, Chang Gung University, Taoyua 833, TaiwanCollege of Medicine, Chang Gung University, Taoyua 833, TaiwanLiver Research Center, Chang Gung Memorial Hospital, Taoyuan 833, TaiwanGraduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 242, TaiwanLiver Research Center, Department of Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, Keelung 204, TaiwanLiver Research Center, Department of Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, Keelung 204, TaiwanCollege of Medicine, Chang Gung University, Taoyua 833, TaiwanCollege of Medicine, Chang Gung University, Taoyua 833, TaiwanPURPOSE: Hepatocellular carcinoma (HCC) is one of the most severe complications in chronic hepatitis B virus (HBV) infection. HCC can still develop in patients with chronic HBV (CHB) infection undergoing antiviral therapy. Several effective scoring systems for the prediction of HCC risk in CHB patients have been established. However, very few of them are designed for CHB patients receiving nucleos(t)ide analogues (NAs) therapy. Furthermore, none are available for HCC risk prediction in CHB patients receiving finite periods of antiviral therapy. METHODS: This study enrolled 790 consecutive treatment-naïve patients with CHB infection who had visited our liver clinics from 2008 to 2012 for pretreatment assessment before receiving antiviral therapies. The treatments were provided at finite periods according to the National Health Insurance Policy in Taiwan. The last follow-up date was 31 December 2021. We analyzed the virological and clinical factors in these 790 CHB patients receiving finite periods of NA treatments and identified the most significant risk factors for HCC to establish a novel predictive scoring system. By using stepwise selection in a multivariate Cox proportional hazards model, we divided the patients into three risk groups. RESULTS: Our predictive scoring system included five independent variables: genotype C (adjusted HR [aHR] = 2.23), NA-withdraw-related hepatitis relapse (aHR = 6.96), male (aHR = 4.19), liver cirrhosis (aHR = 11.14), and T1768A core promoter mutation (aHR = 3.21). This model revealed significant differences in HCC incidence among the three risk groups. The 5-year cumulative HCC risk significantly differed among the three risk groups (low risk: 1.33%, moderate risk: 4.99%, and high risk: 17.46%), with log-rank test <i>p</i> < 0.001. CONCLUSION: Our predictive scoring system is a promising tool for the prediction of HCC in CHB patients receiving finite NA treatments. Genotype C, NA-withdraw-related hepatitis relapse, male gender, liver cirrhosis, and the T1768A HBV core promoter mutation were significant independent risk factors.https://www.mdpi.com/2072-6694/15/13/3343hepatocellular carcinomaantiviral therapyhepatitis B viruspredictive scoringnucleos(t)ide analogue |
| spellingShingle | Chih-Lang Lin Szu-Yuan Wu Ming-Wei Lai Chao-Wei Hsu Wan-Ming Chen An-Tzu Jao Cheng-Hung Chien Ching-Chih Hu Rong-Nan Chien Chau-Ting Yeh Predicting Hepatocellular Carcinoma Risk in Chronic Hepatitis B Patients Receiving Finite Periods of Antiviral Therapy Cancers hepatocellular carcinoma antiviral therapy hepatitis B virus predictive scoring nucleos(t)ide analogue |
| title | Predicting Hepatocellular Carcinoma Risk in Chronic Hepatitis B Patients Receiving Finite Periods of Antiviral Therapy |
| title_full | Predicting Hepatocellular Carcinoma Risk in Chronic Hepatitis B Patients Receiving Finite Periods of Antiviral Therapy |
| title_fullStr | Predicting Hepatocellular Carcinoma Risk in Chronic Hepatitis B Patients Receiving Finite Periods of Antiviral Therapy |
| title_full_unstemmed | Predicting Hepatocellular Carcinoma Risk in Chronic Hepatitis B Patients Receiving Finite Periods of Antiviral Therapy |
| title_short | Predicting Hepatocellular Carcinoma Risk in Chronic Hepatitis B Patients Receiving Finite Periods of Antiviral Therapy |
| title_sort | predicting hepatocellular carcinoma risk in chronic hepatitis b patients receiving finite periods of antiviral therapy |
| topic | hepatocellular carcinoma antiviral therapy hepatitis B virus predictive scoring nucleos(t)ide analogue |
| url | https://www.mdpi.com/2072-6694/15/13/3343 |
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