Factors Associated with Progression to Hepatocellular Carcinoma and to Death from Liver Complications in Patients with HBsAg-Positive Cirrhosis

Tong, Myron J.; Hsien, Carlos; Song, Joanna Jungeun; Kao, Jia‐Horng; Sun, Hai-En; Hsu, Leeyen; Han, Steven‐Huy B.; Durazo, Francisco; Saab, Sammy; Blatt, Lawrence M.

doi:10.1007/s10620-009-0747-y

Cited by 29 publications

(24 citation statements)

References 50 publications

(76 reference statements)

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“… Studies including mixed population: Gordon : 49% Asians, Lim : 79% Polynesians; Sherman : 71% Asians; Tong : 91% Asians; Tong : 78% Asians; Tong : 71% Asians. …”

Section: Resultsmentioning

confidence: 99%

Incidence of hepatocellular carcinoma in untreated subjects with chronic hepatitis B: a systematic review and meta‐analysis

Raffetti

Fattovich

Donato

2016

Liver International

133

110

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Background & aims:In the natural history of hepatitis B virus (HBV) chronic infection, the hepatocellular carcinoma (HCC) risk is unclear. We assessed incidence and predictors of HCC by a systematic review and meta-analysis. Methods: We included longitudinal studies and randomized controlled trials assessing HCC incidence in untreated patients with HBV chronic infection. Incidence rates and their 95% confidence intervals were extracted by each study and pooled together in random effects models. Results: Sixty-six studies were included with a total of 347 859 patients. According to liver disease status, the summary incidence rates were in Europe, North America and East Asia, respectively: (a) asymptomatic carriers .26) respectively. Multivariate meta-regression showed a significant increase in incidence rates for age, and for status of a symptomatic carrier, chronic hepatitis and compensated cirrhosis compared to inactive carrier, but not for geographical area after adjusting for age. An increase in the incidence rates was also observed for alcohol intake ≥60 g/dl, HBV genotype C with respect to B and HBV-DNA serum levels >2000 IU/ml, in Asian studies. Conclusions: Hepatocellular carcinoma risk in untreated subjects with HBV chronic infection is strongly related with age and liver disease status.

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“… Studies including mixed population: Gordon : 49% Asians, Lim : 79% Polynesians; Sherman : 71% Asians; Tong : 91% Asians; Tong : 78% Asians; Tong : 71% Asians. …”

Section: Resultsmentioning

confidence: 99%

Incidence of hepatocellular carcinoma in untreated subjects with chronic hepatitis B: a systematic review and meta‐analysis

Raffetti

Fattovich

Donato

2016

Liver International

133

110

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“…In many countries, including China, the incidence, recurrence and mortality rates of liver cancer remain high. Clinical studies have shown that there is a close relationship between the level of serum AFP and HCC incidence, recurrence and metastasis, and serum AFP level has been used as the main index of prediction for HCC prognosis after hepatectomy [5,10,11]. …”

Section: Discussionmentioning

confidence: 99%

Correlation analysis of preoperative serum alpha-fetoprotein (AFP) level and prognosis of hepatocellular carcinoma (HCC) after hepatectomy

2013

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BackgroundTo investigate the prediction value of preoperative serum alpha-fetoprotein (AFP) level for the prognosis of hepatocellular carcinoma (HCC), by comparing pathological characteristics, recurrence rate and survival rate after hepatectomy.Methods108 cases of HCC patients who received liver resection in our hospital from 2005 to 2011 were enrolled in this study. According to preoperative serum AFP level, the patients were divided into AFP ≤ 20 ng/mL group, AFP 20 to 400 ng/mL group and AFP > 400 ng/mL group, and the clinicopathological and cytopathological features were compared. All the patients were followed up for 24 months, the postoperative recurrence rates and survival rates were compared and analyzed, and the risk factors for HCC postoperative survival rate were studied by multifactor regression analysis.ResultsOf the 108 cases of HCC patients, there were 42 cases in AFP ≤20 ng/mL group, 28 cases in AFP 20–400 ng/mL group and 39 cases in AFP > 400 ng/mL group. It was shown that cell differentiation degrees (χ2 = 20.198, P = 0.000) and microvascular invasion rates (χ2 = 20.358, P = 0.000) were significantly different among the three groups. The AFP ≤ 20 ng/mL group showed higher cell differentiation degrees and significantly lower microvascular invasion rates compared to the other groups (P < 0.05). The follow-up data showed that postoperative 2-year recurrence rate (χ2 = 6.164, P = 0.046), 18-month survival rate (χ2 = 7.647, P = 0.022) and 24-month survival rate (χ2 = 6.725, P = 0.035) of the three groups were significantly different, and we found that the AFP ≤ 20 ng/mL group had lower postoperative 2-year recurrence rate, and higher 18-month survival rate and 24-month survival rate than the other two groups (P <0.05). Multiple logistic regression analysis indicated that tumor diameter (≥ 5 cm) and preoperative serum AFP level (> 400 ng/mL) were closely correlated with HCC postoperative survival rate (P <0.05).ConclusionsIt is shown that preoperative serum AFP level has considerable predictive value for the malignant feature and prognosis of HCC. It is suggested that HCC patients with no contraindication of operation and serum AFP ≤ 20 ng/mL can benefit most from primary treatment of hepatectomy. While HCC patients with serum AFP higher than 20 ng/mL need comprehensive therapy besides surgical resection and close follow up.

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“…One hundred forty-four HBsAg-positive patients had elevated serum aminotransferase levels, and all had liver biopsies (grades 1–3 and stages 1–3), confirming the diagnosis of chronic hepatitis. One hundred thirty patients had abnormal liver tests and had clinical stigmata of chronic liver disease [15]. Liver biopsies were obtained from 109 of these patients, which showed the presence of cirrhosis.…”

Section: Methodsmentioning

confidence: 99%

A comparison of hepatitis B viral markers of patients in different clinical stages of chronic infection

et al. 2010

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PurposeHepatitis B viral markers may be useful for predicting outcomes such as liver-related deaths or development of hepatocellular carcinoma. We determined the frequency of these markers in different clinical stages of chronic hepatitis B infection.Methods We compared baseline hepatitis B viral markers in 317 patients who were enrolled in a prospective study and identified the frequency of these tests in immune-tolerant (IT) patients, in inactive carriers, and in patients with either hepatitis B e antigen (HBeAg)-positive or HBeAg-negative chronic hepatitis or cirrhosis.Results IT patients were youngest (median age 27 years) and HBeAg-negative patients with cirrhosis were oldest (median age 58 years) (p = 0.03 to <0.0001). The male to female ratio was similar both in IT patients and in inactive carriers, but there was a male preponderance both in patients with chronic hepatitis and in patients with cirrhosis (p < 0.0001). The A1896 precore mutants were most prevalent in inactive carriers (36.4%) and HBeAg-negative patients with chronic hepatitis (38.8%; p < 0.0001), and the T1762/A1764 basal core promoter mutants were most often detected in HBeAg-negative patients with cirrhosis (65.1%; p = 0.02). Genotype A was detected only in 5.3% of IT patients, and genotype B was least often detected in both HBeAg-Positive patients with chronic hepatitis and cirrhosis (p = 0.03). The hepatitis B viral DNA levels were lowest in inactive carriers (2.69 log10 IU/mL) and highest in IT patients (6.80 log10 IU/mL; p = 0.02 to <0.0001). At follow-up, HBeAg-positive and HBeAg-negative patients with cirrhosis accounted for 57 of 64 (89.1%) liver-related deaths (p < 0.0001).ConclusionDifferences in baseline hepatitis B viral markers were detected in patients in various clinical stages of hepatitis B virus infection. HBeAg-positive and HBeAg-negative patients with cirrhosis accounted for the majority of the liver-related fatalities.

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Factors Associated with Progression to Hepatocellular Carcinoma and to Death from Liver Complications in Patients with HBsAg-Positive Cirrhosis

Abstract: HBeAg negativity, elevated AFP, and low ALT values predicted HCC development, while HBeAg positivity, abnormal liver tests, and low platelet counts identified patients with non-HCC liver deaths.

Cited by 29 publications

References 50 publications

Incidence of hepatocellular carcinoma in untreated subjects with chronic hepatitis B: a systematic review and meta‐analysis

Incidence of hepatocellular carcinoma in untreated subjects with chronic hepatitis B: a systematic review and meta‐analysis

Correlation analysis of preoperative serum alpha-fetoprotein (AFP) level and prognosis of hepatocellular carcinoma (HCC) after hepatectomy

A comparison of hepatitis B viral markers of patients in different clinical stages of chronic infection

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