Transient elastography is useful for evaluating hepatocellular carcinoma development during entecavir treatment of chronic hepatitis B virus infection

Abstract

Objective: Chronic hepatitis B virus (HBV) infection leads to cirrhosis and hepatocellular carcinoma (HCC). Entecavir (ETV) is effective for treating patients with HBV infection. However, the process of HCC development in patients treated with ETV remains unclear. We used transient elastography to investigate whether HCC development was correlated with liver stiffness (LS).Methods: This retrospective study enrolled 100 patients with chronic HBV infection who were treated with ETV from August 2007 to November 2015. The baseline patient characteristics were as follows: average age 54.8 ± 13.8 years, 64 men, 11 with cirrhosis, 32 positive for HBe antigen, median HBV DNA level 3.0 log copies/ mL, and treatment duration 55.0 ± 28.7 months. One year after the initiation of ETV treatment, laboratory data and viral markers were evaluated. LS values were measured using transient elastography.Results: HBV DNA became undetectable in 90 patients, and alanine aminotransferase (ALT) levels normalized in 86%. Alpha-fetoprotein levels decreased from 12.0 ± 35.7 to 3.2 ± 1.4 ng/mL (p < 0.05). HCC developed in seven patients. The cumulative incidence of HCC at 1, 3, and 5 years was 1%, 4%, and 6%, respectively. HCC development was not affected by HBV DNA negativity or by ALT level normalization. Patients who developed HCC had a higher rate of cirrhosis and higher LS values (≥ 6.8 kPa) than patients who did not develop HCC (cirrhosis: 57.1% vs. 7.5%, p < 0.001; LS values ≥ 6.8 kPa: 83.3% vs. 16.3%, p < 0.001). Conclusion: LS values can be useful for the evaluation of HCC development in patients with chronic HBV infection treated with ETV.