Virological suppression does not prevent the development of hepatocellular carcinoma in HBeAg-negative chronic hepatitis B patients with cirrhosis receiving oral antiviral(s) starting with lamivudine monotherapy: results of the nationwide HEPNET.Gree

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Source: Gut | Posted 5 days ago

Virological suppression does not prevent the development of hepatocellular

carcinoma in HBeAg-negative chronic hepatitis B patients with cirrhosis

receiving oral antiviral(s) starting with lamivudine monotherapy: results of the

nationwide HEPNET.Greece cohort study

Papatheodoridis GV, Manolakopoulos S, Touloumi G, Vourli G, Raptopoulou-Gigi M,

Vafiadis-Zoumbouli I, Vasiliadis T, Mimidis K, Gogos C, Ketikoglou I, Manesis

EK, for the HEPNET.Greece Cohort Study Group; Gut (Jan 2011)

Objective To evaluate the risk and predictors of hepatocellular carcinoma (HCC)

in HBeAg-negative chronic hepatitis B patients of the large HEPNET.Greece cohort

study who received long-term oral antivirals starting with lamivudine

monotherapy. Design Retrospective analysis of HCC incidence in HBeAg-negative

chronic hepatitis B patients from a retrospective-prospective cohort who were

treated with nucleos(t)ide analogue(s) starting with lamivudine monotherapy for

™12 months. Setting A nationwide network of liver centres. Patients 818 patients

were included: 517 with chronic hepatitis B only; 160 with compensated

cirrhosis; 56 with decompensated cirrhosis; 85 with unclassified disease

severity. Interventions All patients were treated with nucleos(t)ide analogue(s)

starting with lamivudine monotherapy. Main outcome measures Development of HCC.

Results During a median follow-up of 4.7 years, HCC developed in 49 (6.0%)

patients. The 5-year cumulative incidence of HCC was higher in patients with

cirrhosis than in those with chronic hepatitis B only (11.5% vs 3.2%,

respectively; p<0.001). HCC developed in 0.7%, 6.7% and 11.7% of patients<50,

50-60 and>60 years old, respectively (p<0.001). Virological on-therapy remission

did not significantly affect the incidence of HCC in all patients or those with

cirrhosis, but it showed a trend for lower HCC incidence in patients with

chronic hepatitis B only (p=0.076). In multivariate analysis, age, gender and

cirrhosis were independently associated with HCC risk regardless of virological

remission. Conclusions Long-term therapy with nucleos(t)ide analogue(s) starting

with lamivudine monotherapy does not eliminate HCC risk in HBeAg-negative

chronic hepatitis B. The risk of HCC is particularly high in patients with

cirrhosis, who should remain under HCC surveillance even during effective

therapy. Older age and male gender remain independent risk factors for HCC,

while virological on-therapy remission does not seem to significantly reduce the

overall incidence of HCC.