Hepatocellular Carcinoma Prediction Beyond Year 5 of Therapy in Chronic Hepatitis B

In white patients with chronic hepatitis B (CHB), the risk for hepatocellular carcinoma (HCC) after the first 5 years of receiving antiviral therapy depends on age, baseline cirrhosis status, and liver stiffness measurement at year 5, according to results from a large multicenter ongoing cohort study published in the Journal of Hepatology.

Although long-term monotherapy with one of the currently recommended nucleos(t)ide analogues results in virologic remission in almost all compliant patients with CHB, hepatitis B virus (HBV) is not eradicated and HCC may still develop in these patients. However, the incidence of HCC is not high after 5 years of nucleos(t)ide analogue therapy and cannot be easily predicted by existing risk scores.

Therefore, researchers assessed predictors and the need for HCC surveillance beyond 5 years of treatment with entecavir (ETF)/tenofovir disoproxil fumarate (TDF) in white patients with CHB with or without compensated cirrhosis. Using data from a total of 1427 patients, the investigators found that in years 5 to 12, HCC was diagnosed in 2.3% (33/1427) of patients with a cumulative incidence of 2.4%, 3.2%, and 3.8% at 8, 10, and 12 years, respectively.

Factors independently associated with increased HCC risk were aged >50 years, baseline cirrhosis, and liver stiffness measurements ≥12 kPa at year 5. In addition, the researchers developed 2 simple HCC risk scores, the CAGE-B and SAGE-B, which offer 100% negative predictive value for HCC, thereby eliminating the need for HCC beyond year 5 in low-risk groups.

The study authors concluded that, “In Caucasians with chronic hepatitis B, the risk of hepatocellular carcinoma (HCC) after the first 5 years of entecavir or tenofovir therapy depends on age, baseline cirrhosis status and liver stiffness at year 5, which can provide simple and reliable risk scores for HCC prediction and surveillance beyond year 5.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Papatheodoridis GV, Sypsa V, Dalekos GN, et al. Hepatocellular carcinoma prediction beyond year 5 of oral therapy in a large cohort of Caucasian patients with chronic hepatitis B [published online January 22, 2020]. J Hepatol. doi:10.1016/j.jhep.2020.01.007