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

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 tria...

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Published in:Liver international Vol. 36; no. 9; pp. 1239 - 1251
Main Authors: Raffetti, Elena, Fattovich, Giovanna, Donato, Francesco
Format: Journal Article
Language:English
Published: United States Blackwell Publishing Ltd 01.09.2016
Subjects:
Alcohol Drinking - epidemiology
Asia, Eastern - epidemiology
Carcinoma, Hepatocellular - epidemiology
Carcinoma, Hepatocellular - virology
DNA, Viral - blood
Europe - epidemiology
hepatitis B
Hepatitis B virus - genetics
Hepatitis B, Chronic - complications
hepatocellular carcinoma
Humans
Incidence
liver
Liver Cirrhosis - complications
Liver Neoplasms - epidemiology
Liver Neoplasms - virology
meta-analysis
North America - epidemiology
Randomized Controlled Trials as Topic
Risk Factors
meta-analysis
hepatitis B
liver
hepatocellular carcinoma
ISSN:1478-3223, 1478-3231
Online Access:Get full text
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Summary: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: 0.07 (95% confidence interval: 0.05–0.09), 0.19 (0.07–0.31) and 0.42 (0.21–0.63) per 100 person‐years, respectively; (b) inactive carriers: 0.03 (0.0–0.10), 0.17 (0.02–0.62) and 0.06 (0.02–0.10), respectively; (c) chronic hepatitis: 0.12 (0.0–0.27), 0.48 (0.22–0.91) and 0.49 (0.32–0.66), respectively; (d) compensated cirrhosis (Child–Pugh A): 2.03 (1.30–2.77), 2.89 (1.23–4.55) and 3.37 (2.48–4.26) 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.
Bibliography:ark:/67375/WNG-28HG3QXR-Q
ArticleID:LIV13142
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ISSN:1478-3223
1478-3231
DOI:10.1111/liv.13142