Whether there is a change of hepatocellular carcinoma (HCC) incidence in chronic hepatitis B patients under long-term therapy with potent nucleos(t) ide analogues is currently unclear. We therefore assessed the HCC incidence beyond year 5 of entecavir/ tenofovir (ETV/ TDF) therapy and tried to determine possible factors associated with late HCC occurrence. This European, 10-center, cohort study included 1,951 adult Caucasian chronic hepatitis B patients without HCC at baseline who received ETV/ TDF for 1 year. Of them, 1,205 (62%) patients without HCC within the first 5 years of therapy have been followed for 5-10 (median, 6.8) years. HCCs have been diagnosed in 101/ 1,951 (5.2%) patients within the first 5 years and 17/ 1,205 (1.4%) patients within 5-10 years. The yearly HCC incidence rate was 1.22% within and 0.73% after the first 5 years (P 5 0.050). The yearly HCC incidence rate did not differ within and after the first 5 years in patients without cirrhosis (0.49% versus 0.47%, P 5 0.931), but it significantly declined in patients with cirrhosis (3.22% versus 1.57%, P 5 0.039). All HCCs beyond year 5 developed in patients older than 50 years at ETV/ TDF onset. Older age, lower platelets at baseline and year 5, and liver stiffness 12 kPa at year 5 were independently associated with more frequent HCC development beyond year 5 in multivariable analysis. No patient with low Platelets, Age, Gender-Hepatitis B score at baseline or year 5 developed HCC. Conclusion: The HCC risk decreases beyond year 5 of ETV/ TDF therapy in Caucasian chronic hepatitis B patients, particularly in those with compensated cirrhosis; older age (especially 50 years), lower platelets, and liver stiffness 12 kPa at year 5 represent the main risk factors for late HCC development.

The risk of hepatocellular carcinoma decreases after the first 5 years of entecavir or tenofovir in Caucasians with chronic hepatitis B / G.V. Papatheodoridis, R. Idilman, G.N. Dalekos, M. Buti, H. Chi, F. Van Boemmel, J.L. Calleja, V. Sypsa, J. Goulis, S. Manolakopoulos, A. Loglio, S. Siakavellas, O. Keskä±n, N. Gatselis, B.E. Hansen, M. Lehretz, J. De La Revilla, S. Savvidou, A. Kourikou, I. Vlachogiannakos, K. Galanis, C. Yurdaydin, T. Berg, M.G. Colombo, R. Esteban, H.L..A. Janssen, P. Lampertico. - In: HEPATOLOGY. - ISSN 0270-9139. - 66:5(2017 Nov), pp. 1444-1453. [10.1002/hep.29320]

The risk of hepatocellular carcinoma decreases after the first 5 years of entecavir or tenofovir in Caucasians with chronic hepatitis B

A. Loglio;M.G. Colombo;P. Lampertico
2017

Abstract

Whether there is a change of hepatocellular carcinoma (HCC) incidence in chronic hepatitis B patients under long-term therapy with potent nucleos(t) ide analogues is currently unclear. We therefore assessed the HCC incidence beyond year 5 of entecavir/ tenofovir (ETV/ TDF) therapy and tried to determine possible factors associated with late HCC occurrence. This European, 10-center, cohort study included 1,951 adult Caucasian chronic hepatitis B patients without HCC at baseline who received ETV/ TDF for 1 year. Of them, 1,205 (62%) patients without HCC within the first 5 years of therapy have been followed for 5-10 (median, 6.8) years. HCCs have been diagnosed in 101/ 1,951 (5.2%) patients within the first 5 years and 17/ 1,205 (1.4%) patients within 5-10 years. The yearly HCC incidence rate was 1.22% within and 0.73% after the first 5 years (P 5 0.050). The yearly HCC incidence rate did not differ within and after the first 5 years in patients without cirrhosis (0.49% versus 0.47%, P 5 0.931), but it significantly declined in patients with cirrhosis (3.22% versus 1.57%, P 5 0.039). All HCCs beyond year 5 developed in patients older than 50 years at ETV/ TDF onset. Older age, lower platelets at baseline and year 5, and liver stiffness 12 kPa at year 5 were independently associated with more frequent HCC development beyond year 5 in multivariable analysis. No patient with low Platelets, Age, Gender-Hepatitis B score at baseline or year 5 developed HCC. Conclusion: The HCC risk decreases beyond year 5 of ETV/ TDF therapy in Caucasian chronic hepatitis B patients, particularly in those with compensated cirrhosis; older age (especially 50 years), lower platelets, and liver stiffness 12 kPa at year 5 represent the main risk factors for late HCC development.
adult; aged; antiviral agents; carcinoma, hepatocellular; cohort studies; europe; european continental ancestry group; female; guanine; hepatitis b, chronic; humans; incidence; liver neoplasms; male; middle aged; risk factors; tenofovir; hepatology
Settore MED/12 - Gastroenterologia
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/531400
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