Early declines in serum hepatitis B RNA levels may ‘serve as independent predictors’ of HCC
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Key takeaways:
- Serum HBV RNA declines at 1 and 2 years were independently associated with risk for HCC.
- Patients with less decline at 1 and 2 years had a 2.22- and 2.09-fold higher risk for HCC.
Declines in serum hepatitis B virus RNA at the first and second year of treatment with nucleos(t)ide analogues correlated with risk for hepatocellular carcinoma and may serve as independent predictors of cancer development.
“Long-term nucleos(t)ide analogue (NA) treatment can significantly decrease but cannot eliminate the HCC risk,” Shi Liu, of Southern Medical University in Guangzhou, China, and colleagues wrote in Clinical Gastroenterology and Hepatology. “Existing HCC risk-prediction scores established in NA-treated patients, such as PAGE B, modified PAGE B and aMAP score, only included commonly measured clinical parameters, such as age, sex, platelet and albumin.”
They continued: “However, our previous study found that serum HBV RNA level was significantly associated with HCC risk in NA-treated patients, suggesting the need to consider this novel viral marker when evaluating the HCC risk in the treated population.”
To investigate the role of HBV RNA kinetics in predicting risk for HCC, Liu and colleagues enrolled 1,374 patients (mean age, 40.04 years; 77% men) treated with entecavir or tenofovir disoproxil fumarate from two prospective chronic HBV cohorts and measured serum HBV RNA levels at baseline and years 1, 2 and 3 of treatment. The primary outcome was HCC development.
At baseline, the median HBV DNA, quantitative hepatitis B surface antigen and HBV RNA levels were 2.6 log10 IU/mL, 3.1 log10 IU/mL and 4.3 log10 copies/mL, respectively.
After a median follow-up of 5.4 years, 76 patients developed HCC, for a 5-year cumulative incidence of 4%. Results also showed that serum HBV RNA declines at 1 year (adjusted HR = 0.7; 95% CI, 0.53-0.91) and 2 years (aHR = 0.71; 95% CI, 0.54-0.94) were independently associated with risk for HCC.
Using cut-off values of 0.4 log10 copies/mL and 0.6 log10 copies/mL at 1 and 2 years, respectively, the researchers reported that 5-year cumulative incidence of HCC was lower among those with greater on-treatment reduction in HBV RNA (1 year: 3.4% vs. 7.3%; 2 years: 4.9% vs. 9.2%). Similarly, less decline at 1 and 2 years was associated with a 2.22-fold and 2.09-fold higher risk, respectively, for HCC.
“Serum HBV RNA declines at year 1 and 2 showed linear associations with HCC risk respectively and could serve as independent predictors of HCC development,” Liu and colleagues wrote. “Incorporating the early on-treatment HBV RNA declines into the existing HCC risk prediction scores could enhance their predictive performance for HCC development and can be useful tools to guide appropriate HCC surveillance strategies in NA-treated patients with chronic HBV.”
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