Occurrence of hepatocellular carcinoma and decompensation in western european patients with cirrhosis type B

Fattovich, Giovanna; Giustina, G.; Schalm, Solko W.; Hadziyannis, Stephanos J.; Sánchez-Tapias, J.M.; Almasio, Piero Luigi; Christensen, Erik; Krogsgaard, Kim; Degos, Françoise; Moura, Miguel Carneiro de; Solinas, A; Noventa, Franco; Realdi, Giuseppe

doi:10.1002/hep.1840210114

Cited by 244 publications

(238 citation statements)

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“…These estimates correspond to a population prevalence of 0.47%, a figure very similar to the United States estimate of 0.42% for the period 1988-1994. 16 In contrast, the adjusted estimate from the national serosurvey provides an estimate of more than 160,000 infections.…”

Section: Discussionmentioning

confidence: 99%

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Estimates of chronic hepatitis B virus infection in Australia, 2000

O’Sullivan

Gidding

Law

et al. 2004

Australian and New Zealand Journal of Public Health

101

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Objectives: To estimate the prevalence of chronic hepatitis B virus (HBV) infection in Australia and attributable proportions associated with specific demographic groups at higher risk of infection. Methods: Two methods were used to estimate prevalence of HBV surface antigen (HBsAg): (1) Population-based: results of a national serosurvey using sera collected opportunistically from laboratories across Australia were used for 1-59 year olds, with the HBsAg prevalence for 50-59 years extrapolated to the population aged 60 years and over; (2) Risk group-based: estimates for selected high-risk groups (injecting drug users, homosexual men, Indigenous Australians and people born in highprevalence countries), using source data from antenatal HBV screening in central Sydney, HBV prevalence studies, and estimates for low-risk groups (first-time blood donors) were combined proportionally to their representation in the population. Results: Prevalence of HBsAg in the national serosurvey increased, with age, from 0.0% for 1-4 and 5-9 year olds to 1.3-1.8% for the 40-49 year age group. Australian population HBsAg prevalence based on minimum and adjusted estimates from this serosurvey were 91,500 (0.49%) and 163,000 (0.87%) infections, respectively. The risk group method estimated an Australian HBsAg prevalence of 88,000 infections (0.47%). Approximately 50% of people with chronic HBV infection were estimated to be immigrants from either South-East Asia (33.3%) or North-East Asia (16.2%). Conclusion:The range of estimates for chronic HBV infection in Australia is broad, reflecting the uncertainty in source data. A national blood survey encompassing a large and representative population sample may help to provide more accurate estimates. A large proportion of people with chronic HBV infection are Asian born.

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Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19] It depends on a number of factors, including the timing of initial infection and the extent of viral replication. 9 An estimated 20-40% of people with chronic HBV infection (HBsAg positive) have evidence of replicative disease as determined by presence of HBeAg and/or high-level HBV DNA.…”

Section: Viruses and Bacteriamentioning

confidence: 99%

Estimates of chronic hepatitis B virus infection in Australia, 2000

O’Sullivan

Gidding

Law

et al. 2004

Australian and New Zealand Journal of Public Health

101

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“…Approximately, 75-80% of primary liver cancers are attributable to persistent viral infections with either hepatitis B virus (HBV) or hepatitis C virus (HCV) [3][4][5][6], and the annual incidence of HCC with cirrhosis is 1-7% [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

et al. 2007

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Background and aims The role of alphafetoprotein (AFP) in the diagnosis and surveillance of hepatocellular carcinoma (HCC) is getting smaller owing to the advances in imaging modalities. The aims of this study were to assess the diagnostic accuracy of tumor markers in small HCC and to find the optimal cutoff value of each tumor marker for efficient surveillance. Methods Studies in all languages were identified by searching MEDLINE from 1982 to 2002. Studies were included when they showed sensitivity and specificity for HCCs 5 cm or smaller and recruited only patients with chronic hepatitis or liver cirrhosis as control. We assessed diagnostic odds ratios (DORs) for the evaluation of diagnostic accuracy of tumor markers and positive likelihood ratios (LRs+) to find the optimal cutoff value. DORs and LRs+ were combined according to the random effect model. The summary receiver operating characteristics (ROC) curve was also assessed. Results Seventeen articles on three tumor markers-AFP, des-gamma-carboxyprothrombin (DCP), and Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3)-were enrolled after full-text evaluation. AFP was inferior to DCP and AFP-L3 in both DOR (4.50 vs. 8.16 and 10.50) and area under the ROC curve (0.647 vs. 0.688 and 0.695). Optimal cutoff values that provide the best LR+ were 200 ng/ml for AFP, 40 mAU/ml for DCP, and 15% for AFP-L3. Conclusions Diagnostic accuracy of AFP in small HCC was substantially limited. Surveillance including other tumor markers with optimal cutoff value should be conducted to confirm the efficacy of the policy.

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“…1,2 Interferon alfa (IFN-␣) has been used as therapy for this disease, leading to a sustained loss of HBV DNA and hepatitis B e antigen (HBeAg) (and seroconversion to anti-HBe) and biochemical improvement (normalization of alanine transaminase [ALT] values) in around 25% to 40% of the treated patients. [2][3][4][5][6][7][8][9][10] However, the remaining patients do not achieve a response, including those patients who relapse after achieving an initial response and patients who do not respond.…”

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confidence: 99%

Retreatment of chronic hepatitis B e antigen-positive patients with recombinant interferon alfa-2a

et al. 1999

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It has been proven that chronic hepatitis B virus (HBV) infection may have a progressive course ending in liver cirrhosis or hepatocellular carcinoma. 1,2 Interferon alfa (IFN-␣) has been used as therapy for this disease, leading to a sustained loss of HBV DNA and hepatitis B e antigen (HBeAg) (and seroconversion to anti-HBe) and biochemical improvement (normalization of alanine transaminase [ALT] values) in around 25% to 40% of the treated patients. 2-10 However, the remaining patients do not achieve a response, including those patients who relapse after achieving an initial response and patients who do not respond. These patients may potentially benefit from another cycle of IFN-␣ treatment.Attempts in pilot studies of retreatment with IFN-␣ for previous nonresponders provided no definite conclusions on its possible efficacy in chronic HBV. 11 No controlled trial evaluating the benefits of retreatment of chronic HBV with IFN-␣ has been published. The objective of our study has been to determine whether a second course of IFN-␣, given during 6 months, is safe and acceptable, and whether it results in a significantly higher treatment response (loss of HBeAg and HBV DNA) than no treatment in previously nonresponder patients with chronic HBV. PATIENTS AND METHODSStudy Design. This study was designed as a multicenter (see Appendix) randomized controlled trial in patients who failed to respond to a previous cycle of IFN-␣. Assuming that patients with no treatment show a 5% response, and patients with retreatment 25% (a 20% difference), 7 a total number of 145 patients was needed to detect a significant difference at the 5% level with a power of 80%, taking into account a possible 25% drop-out rate during the study. The inclusion period started in April 1992 and ended in December 1996. At that time, 62 patients who were HBeAg-and HBV DNA-positive in serum with abnormal ALT values (documented at least 3 times within the 6 months screening period) and a chronic HBV 12 documented in a liver biopsy obtained within 1 year before inclusion had been enrolled. The patients should have undergone a previous treatment of only one course of any type of IFN-␣ treatment (recombinant or lymphoblastoid) for at least 12 weeks with a minimum of 13.5 million units (MU) per week 8,13 ; at the end of the first IFN-␣ cycle ( at least 6 months before enrollment in this study) patients should have been HBeAg-positive.The following patient exclusion criteria were used: (1) evidence of any other type of liver disease, i.e., anti-hepatitis C virus or anti-hepatitis D virus positive, alcohol, ascites, bleeding varices, or Abbreviations: HBV, hepatitis B virus; HBeAg, hepatitis B virus e antigen; ALT, alanine transaminase; HBsAg, hepatitis B virus surface antigen; IFN-␣, interferon alfa.From the

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Occurrence of hepatocellular carcinoma and decompensation in western european patients with cirrhosis type B

Cited by 244 publications

References 19 publications

Estimates of chronic hepatitis B virus infection in Australia, 2000

Estimates of chronic hepatitis B virus infection in Australia, 2000

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

Retreatment of chronic hepatitis B e antigen-positive patients with recombinant interferon alfa-2a

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