Accuracy of Risk Scores for Patients With Chronic Hepatitis B Receiving Entecavir Treatment

Wong, Grace Lai–Hung; Chan, Henry Lik‐Yuen; Tse, Pete C.H.; Tse, Yee‐Kit; Mak, Christy Wing‐Hin; Lee, Stanley King–Yeung; Ip, Zoe Man–Yi; Lam, Andrew Ting–Ho; Iu, Henry Wing–Hang; Leung, Joyce May–Sum; Wong, Vincent Wai‐Sun

doi:10.1053/j.gastro.2013.02.002

Cited by 158 publications

(179 citation statements)

References 28 publications

(29 reference statements)

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“…Currently, there is no evidence from prospective randomized controlled trials that show a superiority in terms of HCC prevention with the newer NAs, entecavir and tenofovir disoproxil fumarate, that have a high antiviral potency as well as a high barrier to drug resistance [12]. Risk scores based on demographic (age, sex), clinical (cirrhosis, ALT, albumin, and bilirubin) and virologic characteristics (HBeAg status, HBV DNA) have been developed and predict HCC in Asian chronic hepatitis B patients treated with entecavir, but to a lesser extend in Caucasians [17,18]. Because intrahepatic cccDNA cannot be eliminated so far, even the new potent drugs are not able to fully eliminate the risk of HCC in chronic hepatitis B-infected patients [19].…”

Section: Strategies With a Focus On Hbv-related Hccmentioning

confidence: 99%

Prevention of Hepatocellular Carcinoma

Schütte

Balbisi

Malfertheiner

2016

Gastrointest Tumors

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The epidemiology of hepatocellular carcinoma (HCC) has significantly changed throughout the past decade and will continue to do so in the future as a consequence of effective primary prevention and treatment of virus-related liver diseases. However, other risk factors for HCC are constantly on the rise, including alcoholic liver disease and nonalcoholic fatty liver disease. The knowledge on these and further risk factors associated with an increased risk of HCC provide the opportunity and chance for the development and implementation of successful preventive strategies to decrease the worldwide burden of HCC. This mini-review gives a short overview on current strategies in primary, secondary, and tertiary prevention of HCC.

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Section: Strategies With a Focus On Hbv-related Hccmentioning

confidence: 99%

Prevention of Hepatocellular Carcinoma

Schütte

Balbisi

Malfertheiner

2016

Gastrointest Tumors

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“…We minimized bias by adjusting all clinical outcomes for the Model for End-Stage Liver Disease score, together with maintained viral suppression, another important difference, 9 among patients with liver cirrhosis using Cox's proportional hazard model. 1 Risk reduction remained robust.…”

Section: Department Of Medical Research Digestive Centermentioning

confidence: 99%

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2014

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In the study, ultrasonography of the abdomen was performed every 1-2 years for surveillance of hepatocellular carcinoma (HCC) or, more frequently, if the alpha-fetoprotein level rose above 20 lg/ L. This appeared not to be in accord with the recommendations of screening intervals of every 6 months by the Asian Pacific Association for the Study of the Liver or American Association for the Study of liver Diseases. 2,3 A high proportion of hepatic events were ascribed to variceal bleeding. If complied with the recommendations to prevent first variceal bleeding, these serious events could be effectively reduced. 4,5 Most important, baseline clinical characteristics varied significantly between both cohorts. Though baseline data appeared to be milder disease in the entire untreated control cohort than entecavir-treated cohort, patients with cirrhosis in the untreated control cohort were more severe than the entecavir-treated cohort, as expressed by Child-Pugh's score. There was no difference in hepatic events between both cohorts, except among patients with cirrhosis. Based on sensitivity analyses among patients with cirrhosis, the risk of hepatic events is greatly reduced by entecavir among patients with advanced liver disease, as reflected by low platelet counts, low serum albumin, high total bilirubin, higher Child-Pugh score, and Model for End-Stage Liver Disease score. These baseline clinical parameters were all worse in the untreated control cohort than the entecavirtreated cohort. Duration of follow-up was significantly longer in the untreated control cohort. All these factors may elicit significant bias between groups. Use of entecavir is proven to be beneficial for hepatitis B virus patients to reverse fibrosis and cirrhosis 6 ; however, the evidence of reduction in hepatic events and incidence of HCC, as revealed by the current study and previous work, 7 was still flawed with significant bias. Long-term follow-up of controlled studies would be more convincing. Reply:We thank Dr. Lo for his interest in our study. 1 His first point related to the frequency of abdominal ultrasonography for surveillance of hepatocellular carcinoma every 1-2 years, instead of every 6 months, according to the international guidelines. [2][3][4] This was the result of limited resources of radiology services in our public sector, which is often an issue in some regions. 5 Instead, alphafetoprotein (AFP) was tested during every visit. In our recent analysis, the specificity of AFP was as high as 99% at a cut-off value of 20 mg/L in patients receiving entecavir. 6

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“…Liver cirrhosis has been accepted worldwide as the precondition of the non-invasive diagnostic criteria for HCC. However, in hepatitis B virus (HBV)-endemic areas such as China, only 40–50% of all HCC patients reported cirrhosis [7-9]. The other nearly 50% of the HCC patients were non-cirrhotic patients with chronic hepatitis B [8, 9], and because these patients did not meet the non-invasive diagnostic criteria, biopsies were obtained to confirm the diagnosis of HCC.…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Diagnostic Criteria for Hepatocellular Carcinoma in Hepatitis B Virus-Endemic Areas: Is Cirrhosis Indispensable?

Huang

Liao

Huang

et al. 2018

Dig Dis

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Aim: To confirm whether cirrhosis is indispensable for the non-invasive diagnostic criteria for hepatocellular carcinoma (HCC) in hepatitis B virus (HBV)-endemic areas. Methods: Between January 2014 and December 2014, a total of 409 patients with pathologically proven focal liver lesions who underwent contrast-enhanced ultrasound (CEUS) were recruited from our institution. Clinical liver cirrhosis, HBV/HCV infection and HCC-typical vascular pattern of the targeted lesion on CEUS were evaluated. The following 3 criteria were applied to these patients to diagnose HCC: criterion 1, clinical liver cirrhosis and HCC-typical vascular pattern; criterion 2, HBV/HCV infection and HCC-typical vascular pattern; criterion 3, HBV/HCV infection or clinical liver cirrhosis and HCC-typical vascular pattern. Pathological reports were considered the gold standard. Results: A total of 311 patients had confirmed HCC by pathology. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and area under the ROC curve for criterion 1 were 29.6, 90.8, 44.3, 91.1, 28.9, and 0.60% respectively. For criterion 2, they were 83.3, 74.5, 81.2, 91.2, 58.4, and 0.79%, respectively, and for criterion 3, they were 86.2, 72.5, 82.9, 90.9, 62.3, and 0.79% respectively. Conclusions: In HBV-endemic areas, when using the HBV/HCV infection instead of cirrhosis as the precondition of the non-invasive diagnostic criteria for HCC, we should be aware of the potential false positive. Cirrhosis still plays an important role in the non-invasive diagnostic criteria for HCC because of the high specificity.

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Accuracy of Risk Scores for Patients With Chronic Hepatitis B Receiving Entecavir Treatment

Cited by 158 publications

References 28 publications

Prevention of Hepatocellular Carcinoma

Prevention of Hepatocellular Carcinoma

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Non-Invasive Diagnostic Criteria for Hepatocellular Carcinoma in Hepatitis B Virus-Endemic Areas: Is Cirrhosis Indispensable?

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