TY - JOUR
TI - The risk of hepatocellular carcinoma decreases after the first 5 years of entecavir or tenofovir in Caucasians with chronic hepatitis B
AU - Papatheodoridis, G.V.
AU - Idilman, R.
AU - Dalekos, G.N.
AU - Buti, M.
AU - Chi, H.
AU - van Boemmel, F.
AU - Calleja, J.L.
AU - Sypsa, V.
AU - Goulis, J.
AU - Manolakopoulos, S.
AU - Loglio, A.
AU - Siakavellas, S.
AU - Keskın, O.
AU - Gatselis, N.
AU - Hansen, B.E.
AU - Lehretz, M.
AU - de la Revilla, J.
AU - Savvidou, S.
AU - Kourikou, A.
AU - Vlachogiannakos, I.
AU - Galanis, K.
AU - Yurdaydin, C.
AU - Berg, T.
AU - Colombo, M.
AU - Esteban, R.
AU - Janssen, H.L.A.
AU - Lampertico, P.
JO - Annals of Hepatology
PY - 2017
VL - 66
TODO - 5
SP - 1444-1453
PB - John Wiley and Sons Inc
SN - null
TODO - 10.1002/hep.29320
TODO - alpha fetoprotein;  entecavir;  hepatitis B surface antigen;  tenofovir;  virus DNA;  antivirus agent;  entecavir;  guanine;  tenofovir, adult;  alcohol consumption;  antiviral therapy;  Article;  cancer incidence;  cancer risk;  Caucasian;  chronic hepatitis B;  cohort analysis;  disease severity;  female;  follow up;  human;  liver cell carcinoma;  liver cirrhosis;  liver stiffness;  major clinical study;  male;  priority journal;  transient elastography;  treatment duration;  aged;  analogs and derivatives;  Carcinoma, Hepatocellular;  clinical trial;  complication;  Europe;  Hepatitis B, Chronic;  incidence;  Liver Neoplasms;  middle aged;  multicenter study;  risk factor;  virology, 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
TODO - 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 = 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 = 0.931), but it significantly declined in patients with cirrhosis (3.22% versus 1.57%, P = 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. (Hepatology 2017;66:1444–1453). © 2017 by the American Association for the Study of Liver Diseases.
ER -