Partial Virological Response after 2 Years of Entecavir Therapy Increases the Risk of Hepatocellular Carcinoma in Patients with Hepatitis B Virus-Associated Cirrhosis

: The clinical significance of partial virological response (PVR) in patients undergoing antiviral therapy is not well known. This study investigated whether PVR after 2 years of entecavir (ETV) therapy is associated with hepatocellular carcinoma (HCC) development in cirrhotic patients. A total of 4...

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Published in:Gut and liver Vol. 15; no. 3; pp. 430 - 439
Main Authors: Shin, Seung Kak, Yim, Hyung Joon, Kim, Jeong Han, Lee, Chan Uk, Yeon, Jong Eun, Suh, Sang Jun, Jung, Young Kul, Kim, Yun Soo, Kim, Ju Hyun, Kwon, Oh Sang
Format: Journal Article
Language:English
Published: Korea (South) Editorial Office of Gut and Liver 15.05.2021
Gastroenterology Council for Gut and Liver
거트앤리버 소화기연관학회협의회
Subjects:
entecavir
hepatitis b virus
hepatocellular carcinoma
liver cirrhosis
Original
partial virological response
내과학
Partial virological response
Hepatocellular carcinoma
Hepatitis B virus
Liver cirrhosis
Entecavir
ISSN:1976-2283, 2005-1212, 2005-1212
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Summary:: The clinical significance of partial virological response (PVR) in patients undergoing antiviral therapy is not well known. This study investigated whether PVR after 2 years of entecavir (ETV) therapy is associated with hepatocellular carcinoma (HCC) development in cirrhotic patients. A total of 472 naïve patients with hepatitis B virus (HBV)-associated cirrhosis who were treated with ETV for at least 2 years were retrospectively enrolled. Clinical characteristics, laboratory data, PVR, and noninvasive fibrosis markers (aspartate aminotransferase to platelet ratio and FIB-4 index) at 2 years after ETV commencement were analyzed for HCC risk. After excluding those who developed HCC within 2 years of ETV therapy, 359 patients (mean age, 51±10 years; male 64.3%) were examined. During a median follow-up of 82 months, 80 patients developed HCC. In the univariate analysis, older age (hazard ratio [HR], 1.056; p<0.001), PVR (HR, 2.536; p=0.002), higher aspartate aminotransferase (HR, 1.018; p=0.005), lower albumin level (HR, 0.463; p<0.001), lower platelet count (HR, 0.993; p=0.01), and higher FIB-4 index (HR, 1.141; p<0.001) at 2 years after ETV commencement were risk factors for HCC. In the multivariate analysis, older age (HR, 1.046; 95% confidence interval [CI], 1.022 to 1.072; p<0.001), PVR (HR, 2.358; 95% CI, 1.310 to 4.245; p=0.004), and higher FIB-4 index (HR, 1.103; 95% CI, 1.035 to 1.177; p=0.003) were independent risk factors. PVR and higher FIB-4 index after 2 years of ETV therapy were independent risk factors for HCC. Therefore, efforts to accomplish a complete virological response and reduce the FIB-4 index should be made.
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Seung Kak Shin and Hyung Joon Yim contributed equally to this work as first authors.
ISSN:1976-2283
2005-1212
2005-1212
DOI:10.5009/gnl20074