Reduced risk of hepatocellular carcinoma by achieving a subcirrhotic liver stiffness through antiviral agents in hepatitis B virus‐related advanced fibrosis or cirrhosis

Background and Aim A subcirrhotic range of liver stiffness (sc‐LS), assessed by transient elastography, is associated with better outcomes in patients with chronic hepatitis B (CHB). We investigated whether the achievement of sc‐LS by antiviral therapy (AVT) reduced the risk of developing hepatocell...

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Published in:Journal of Gastroenterology and Hepatology Vol. 33; no. 2; pp. 503 - 510
Main Authors: Kim, Byung Seok, Seo, Yeon Seok, Kim, Young Seok, Lee, Chang Hyeong, Lee, Han Ah, Um, Soon Ho, Yoo, Jeong‐Ju, Kim, Sang Gyune, Suh, Sang Jun, Jung, Young Kul, Ahn, Sang Hoon, Han, Kwang‐Hyub, Yim, Hyung Joon, Kim, Seung Up
Format: Journal Article
Language:English
Published: Australia Wiley 01.02.2018
Wiley Subscription Services, Inc
Subjects:
Aged
Antiviral Agents
Antiviral Agents - therapeutic use
antiviral therapy
Carcinoma, Hepatocellular
Carcinoma, Hepatocellular - etiology
Carcinoma, Hepatocellular - prevention & control
Chronic/complications/drug therapy Hepatitis B
Cirrhosis
Female
Fibrosis
Hepatitis
Hepatitis B
Hepatitis B, Chronic
Hepatitis B, Chronic - complications
Hepatitis B, Chronic - drug therapy
Hepatocellular carcinoma
Hepatocellular/etiology/prevention & control Carcinoma
Humans
Liver cancer
Liver Cirrhosis
Liver Cirrhosis - etiology
liver fibrosis
Liver Neoplasms
Liver Neoplasms - etiology
Liver Neoplasms - prevention & control
Liver Neoplasms/etiology/prevention & control
liver stiffness
Male
Middle Aged
Multivariate analysis
Population studies
Risk
transient elastography
liver fibrosis
hepatitis B
liver stiffness
transient elastography
antiviral therapy
cirrhosis
hepatocellular carcinoma
ISSN:0815-9319, 1440-1746, 1440-1746
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Summary:Background and Aim A subcirrhotic range of liver stiffness (sc‐LS), assessed by transient elastography, is associated with better outcomes in patients with chronic hepatitis B (CHB). We investigated whether the achievement of sc‐LS by antiviral therapy (AVT) reduced the risk of developing hepatocellular carcinoma (HCC) in patients with CHB‐related advanced fibrosis or cirrhosis. Methods In total, 209 patients with CHB‐related advanced fibrosis or cirrhosis, who received paired transient elastography examinations during AVT between 2007 and 2012, were enrolled. The cut‐off LS value for ultrasonographic cirrhosis was defined as 11.6 kPa. Results The median age of the study population was 51 years, with males predominating (n = 138, 66.0%). The median LS value at enrollment was 14.1 kPa (interquartile range: 9.5–24.1 kPa). After 2 years of AVT, 140 (67.0%) patients achieved sc‐LS. During the study period, 28 (13.4%) patients developed HCC after 2 years of AVT. On multivariate analysis, the achievement of sc‐LS after AVT was independently associated with a decreased risk of HCC development (hazard ratio [HR] = 0.485, P = 0.047), whereas older age (HR = 1.071) and male gender (HR = 3.704) were independently associated with an increased HCC risk (both P < 0.05). Patients with a cirrhotic range of LS value after 2 years of AVT were at a higher risk of HCC development than those with sc‐LS (log‐rank test, P = 0.020). Conclusions The achievement of sc‐LS after AVT can reduce the risk of HCC development in patients with CHB, even when advanced fibrosis or cirrhosis is apparent on starting AVT.
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ISSN:0815-9319
1440-1746
1440-1746
DOI:10.1111/jgh.13854