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Risk for HCC in chronic HBV higher in men, older women

Following HBsAg seroclearance, women aged older than 50 years and men with chronic hepatitis B had significant risk for developing hepatocellular carcinoma, whereas women aged 50 years or younger had no risk for HCC up to 5 years, according to results of a recently published study.

“The results of this study have laid down some guidance on HCC surveillance for [chronic HBV] patients [who] achieved HBsAg seroclearance,” the researchers wrote. “Risk of HCC may still persist in [chronic HBV] patients with HBsAg seroclearance. HCC surveillance may not be necessary for female patients with HBsAg seroclearance at 50 years or younger, but may still be cost-effective for other patients.”

In the retrospective study, researchers gathered data on 4,568 patients with chronic HBV from the Clinical Data Analysis Reporting System of the Hong Kong Hospital Authority who were positive for HBsAg between Jan. 1, 2000, and Aug. 31, 2016. Mean patient age was 56.7 years and 62.9% were men. Patients were followed to death, diagnosis of HCC, 5 years of follow-up or to the end of follow-up on Oct. 31, 2016.

Fifty-four patients developed HCC with incidence rates of 0.9% at 1 year (95% CI, 0.6-1.2), 1.3% at 3 years (95% CI, 1-1.7) and 1.5% at 5 years (95% CI, 1.1-1.9).

Compared with patients aged 50 years or younger at the time of HBsAg seroclearance, patients aged over 50 years (n = 3,254) were more likely to be men (P < .001), less likely to receive nucleos(t)ide analogue treatment (P < .001) and had a higher risk for HCC (P < .001), lower platelet counts (P < .001), lower serum albumin (P < .001) and higher serum alanine aminotransferase (P = .001). Additionally, patients aged over 60 years had a higher risk for HCC than those at age 60 years (P = .006).

Men had a significantly higher risk for HCC compared with women after HBsAg seroclearance (P = .005), whereas women aged 50 years or younger in this cohort had no risk after seroclearance up to 5 years. Men aged 50 years or younger and women aged over 50 years both had intermediate to comparable risks for HCC after HBsAg seroclearance.

After multivariable analysis, the researchers found that patient age older than 50 years (HR = 4.31; 95% CI, 1.72-10.84) and male sex (HR = 2.47; 95% CI, 1.24-4.91) were independent risk factors for HCC after HBsAg seroclearance.

“While the clearance of covalently closed circular DNA in [chronic HBV] patients is almost impossible with current [nucleos(t)ide analogue] treatment, HBsAg seroclearance is regarded as a surrogate of ultimate immune control of HBV and a realistic antiviral treatment endpoint, as it leads to reduced risk of HCC. However, the risk of HCC persists in patients [who] achieved HBsAg seroclearance,” the researchers concluded. “[Nucleos(t)ide analogue]-induced HBsAg seroclearance may have abolished the HCC risk in all female and young male patients; however, a small risk still persists in male patients above 50 years old at the time of HBsAg seroclearance.” – by Talitha Bennett

Disclosure: Yip reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.