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HBsAg seroclearance unassociated with reduced risk for HCC

In a case-control study performed among Alaska Natives, hepatitis B surface antigen seroclearance was not associated with a decreased risk for developing hepatocellular carcinoma.

“Since the risk of liver cancer persists among adults with apparent cure of the infection, they might still need to be followed closely,” Prabhu P. Gounder, MD, of the national center for emerging and zoonotic infectious disease at the CDC, Anchorage, Alaska, said in a press release.

Gounder and colleagues compared outcomes of 238 Alaska Natives with HBsAg seroclearance (cases) with 435 patients without HBsAg seroclearance (controls) found in the Alaska Tribal Health System registry between 1982 and 2013.

“No recommendations for HCC surveillance exist for persons with spontaneous HBsAg seroclearance because of conflicting data on HCC risk in this population. … We conducted [this] nested case-control study among this cohort of HBV-infected [Alaska Native] persons to compare the risk for developing HCC after HBsAg seroclearance with the risk for HCC among persons who did not clear HBsAg,” Gounder and colleagues wrote.

Characteristics of the case patients were similar to the controls in terms of age, sex and HBV genotype. Four of the case patients and nine of the controls had HCC.

Results of a Cox proportional hazards model analysis showed the HCC rate per 100,000 persons was similar between the patients with seroclearance (n = 132) and the controls (n = 178).

When comparing case and control patients, the adjusted HR’s were similar for HCC (0.7; 95% CI, 0.2–2.4), increased for each 1-year increment for age (1.1; 95% CI, 1.0–1.1) and was higher if the initial hepatitis B e antigen was positive (3.5; 95% CI, 1.1–11), according to the research.

Patients with HBsAg seroclearance had longer person-years of follow-up (11.7 years) compared with the patients without HBsAg seroclearance control-patients (10.1 years; P = .04).

“Our study is unique because we attempted to isolate the effect of HBsAg seroclearance on subsequent risk for developing HCC,” the researchers concluded. “The results indicate that HBsAg seroclearance was not associated with reduced risk for HCC. … Further research to better understand the factors early in the course of infection that predict future risk for developing HCC risk could help to identify a subset of immune-inactive patients who might benefit from early treatment.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.