Determinants of hepatocellular carcinoma in cirrhotic patients treated with nucleos(t)ide analogues for chronic hepatitis B. (26th February 2014)

• Record Type: Journal Article
• Authors: Hsu, Yao-Chun; Wu, Chun-Ying; Lane, Hsien-Yuan; Chang, Chi-Yang; Tai, Chi-Ming; Tseng, Cheng-Hao; Lo, Gin-Ho; Perng, Daw-Shyong; Lin, Jaw-Town; Mo, Lein-Ray
• Is Part Of: Journal of antimicrobial chemotherapy. Volume 69:Number 7(2014:Jul.)
• Page Start: 1920
• Page End: 1927
• Publication Date: 2014-02-26
• Subjects: hepatitis B virus -- liver cirrhosis -- antiviral therapy -- diabetes mellitus -- risk stratification; Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; 615.58
• DOI: 10.1093/jac/dku041
• Languages: English
• ISSNs: 0305-7453

Abstract

Abstract : Objectives: We aimed to identify determinants of hepatocellular carcinoma (HCC) in cirrhotic patients who received nucleos(t)ide analogues for chronic hepatitis B (CHB). Patients and methods: This retrospective-prospective study screened all patients ( n = 1630) who received antiviral therapy for CHB between 1 September 2007 and 31 March 2013 at the E-Da Hospital and enrolled 210 consecutive cirrhotic patients with pretreatment viral DNA >2000 IU/mL. Those who developed HCC within 3 months of treatment were excluded. All participants were observed until occurrence of HCC, death or 1 January 2014. The incidence and determinants of HCC were estimated using competing risk analyses adjusted for mortality. Results: Thirty-five (16.7%) patients developed HCC during a median follow-up of 25.2 months (IQR, 16.3–37.3 months), with a cumulative incidence of 24.1% (95% CI, 16.3%–32.0%) at 5 years. Multivariate-adjusted analyses identified age >55 years [adjusted hazard ratio (HR), 2.19; 95% CI, 1.03–4.66], male gender (adjusted HR, 3.07; 95% CI, 1.05–9.02), model for end-stage liver disease (MELD) score >12 points (adjusted HR, 2.16; 95% CI, 1.10–4.23) and diabetes mellitus (DM; adjusted HR, 3.49; 95% CI, 1.54–7.91) as independent risk factors after adjusting for multiple covariates, including antidiabetes medication. A scoring formula that used information on age, gender, MELD score, DM and antidiabetes regimen significantly discriminated patients at high or low risk of HCC, with sensitivity and specificity of 82.9% and 62.3%, respectively. Conclusions: Age, gender, hepatic dysfunction, DM and medication for DM are baseline factors that stratify the risk of HCC in cirrhotic patients who receive nucleos(t)ide analogues for CHB.