Increased risk of hepatocellular carcinoma in chronic hepatitis B patients with transient elastography-defined subclinical cirrhosis

Mi Na Kim, Seungup Kim, Beom Kyung Kim, Junyong Park, doyoung kim, SangHoon Ahn, Ki Jun Song, Young Nyun Park, KwangHyub Han

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Abstract

Early detection of liver cirrhosis in its subclinical stage is of paramount importance to identify high-risk individuals for developing hepatocellular carcinoma (HCC). This study investigated whether transient elastography (TE) can identify patients with subclinical cirrhosis (SCC) who are at increased risk of developing HCC among chronic hepatitis B (CHB) patients without clinical evidence of cirrhosis. A total of 2,876 CHB patients without clinical cirrhosis who received TE examinations between April 2006 and December 2012 were enrolled in this prospective study. SCC was defined as a nonclinical cirrhosis, but with a liver stiffness (LS) value ≥13 kilopascals (kPa). Mean age of the study population was 46.1 years, and male gender was predominant (n=1,775; 61.7%). Mean LS value was 7.9 kPa, and SCC was identified in 285 (9.9%) patients. During the median follow-up period of 48.9 months (range, 6.6-96.2), HCC developed in 16 patients (13.3 per 1,000 person-years) in the SCC group and 36 (3.4 per 1,000 person-years) in the non-SCC group. Cumulative incidence rate of HCC in the SCC group was significantly higher than that in the non-SCC group (P<0.001, log-rank test). On multivariate analysis, SCC was independently associated with a risk of developing HCC, regardless of antiviral therapy (without antiviral therapy: hazard ratio [HR]: 4.680; 95% confidence interval [CI]: 1.187-18.441; P=0.027; with antiviral therapy: HR, 3.344; 95% CI: 1.526-7.328; P=0.003). Conclusion: TE can identify CHB patients with SCC who are at increased risk of developing HCC, even when cirrhosis is not clinically apparent.

Original languageEnglish
Pages (from-to)1851-1859
Number of pages9
JournalHepatology
Volume61
Issue number6
DOIs
Publication statusPublished - 2015 Jun 1

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Elasticity Imaging Techniques
Chronic Hepatitis B
Hepatocellular Carcinoma
Fibrosis
Antiviral Agents
Confidence Intervals
Liver
Liver Cirrhosis

All Science Journal Classification (ASJC) codes

  • Hepatology

Cite this

@article{e6bc803580b146b3a0c812d8b311d44b,
title = "Increased risk of hepatocellular carcinoma in chronic hepatitis B patients with transient elastography-defined subclinical cirrhosis",
abstract = "Early detection of liver cirrhosis in its subclinical stage is of paramount importance to identify high-risk individuals for developing hepatocellular carcinoma (HCC). This study investigated whether transient elastography (TE) can identify patients with subclinical cirrhosis (SCC) who are at increased risk of developing HCC among chronic hepatitis B (CHB) patients without clinical evidence of cirrhosis. A total of 2,876 CHB patients without clinical cirrhosis who received TE examinations between April 2006 and December 2012 were enrolled in this prospective study. SCC was defined as a nonclinical cirrhosis, but with a liver stiffness (LS) value ≥13 kilopascals (kPa). Mean age of the study population was 46.1 years, and male gender was predominant (n=1,775; 61.7{\%}). Mean LS value was 7.9 kPa, and SCC was identified in 285 (9.9{\%}) patients. During the median follow-up period of 48.9 months (range, 6.6-96.2), HCC developed in 16 patients (13.3 per 1,000 person-years) in the SCC group and 36 (3.4 per 1,000 person-years) in the non-SCC group. Cumulative incidence rate of HCC in the SCC group was significantly higher than that in the non-SCC group (P<0.001, log-rank test). On multivariate analysis, SCC was independently associated with a risk of developing HCC, regardless of antiviral therapy (without antiviral therapy: hazard ratio [HR]: 4.680; 95{\%} confidence interval [CI]: 1.187-18.441; P=0.027; with antiviral therapy: HR, 3.344; 95{\%} CI: 1.526-7.328; P=0.003). Conclusion: TE can identify CHB patients with SCC who are at increased risk of developing HCC, even when cirrhosis is not clinically apparent.",
author = "Kim, {Mi Na} and Seungup Kim and Kim, {Beom Kyung} and Junyong Park and doyoung kim and SangHoon Ahn and Song, {Ki Jun} and Park, {Young Nyun} and KwangHyub Han",
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Increased risk of hepatocellular carcinoma in chronic hepatitis B patients with transient elastography-defined subclinical cirrhosis. / Kim, Mi Na; Kim, Seungup; Kim, Beom Kyung; Park, Junyong; kim, doyoung; Ahn, SangHoon; Song, Ki Jun; Park, Young Nyun; Han, KwangHyub.

In: Hepatology, Vol. 61, No. 6, 01.06.2015, p. 1851-1859.

Research output: Contribution to journalArticle

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T1 - Increased risk of hepatocellular carcinoma in chronic hepatitis B patients with transient elastography-defined subclinical cirrhosis

AU - Kim, Mi Na

AU - Kim, Seungup

AU - Kim, Beom Kyung

AU - Park, Junyong

AU - kim, doyoung

AU - Ahn, SangHoon

AU - Song, Ki Jun

AU - Park, Young Nyun

AU - Han, KwangHyub

PY - 2015/6/1

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N2 - Early detection of liver cirrhosis in its subclinical stage is of paramount importance to identify high-risk individuals for developing hepatocellular carcinoma (HCC). This study investigated whether transient elastography (TE) can identify patients with subclinical cirrhosis (SCC) who are at increased risk of developing HCC among chronic hepatitis B (CHB) patients without clinical evidence of cirrhosis. A total of 2,876 CHB patients without clinical cirrhosis who received TE examinations between April 2006 and December 2012 were enrolled in this prospective study. SCC was defined as a nonclinical cirrhosis, but with a liver stiffness (LS) value ≥13 kilopascals (kPa). Mean age of the study population was 46.1 years, and male gender was predominant (n=1,775; 61.7%). Mean LS value was 7.9 kPa, and SCC was identified in 285 (9.9%) patients. During the median follow-up period of 48.9 months (range, 6.6-96.2), HCC developed in 16 patients (13.3 per 1,000 person-years) in the SCC group and 36 (3.4 per 1,000 person-years) in the non-SCC group. Cumulative incidence rate of HCC in the SCC group was significantly higher than that in the non-SCC group (P<0.001, log-rank test). On multivariate analysis, SCC was independently associated with a risk of developing HCC, regardless of antiviral therapy (without antiviral therapy: hazard ratio [HR]: 4.680; 95% confidence interval [CI]: 1.187-18.441; P=0.027; with antiviral therapy: HR, 3.344; 95% CI: 1.526-7.328; P=0.003). Conclusion: TE can identify CHB patients with SCC who are at increased risk of developing HCC, even when cirrhosis is not clinically apparent.

AB - Early detection of liver cirrhosis in its subclinical stage is of paramount importance to identify high-risk individuals for developing hepatocellular carcinoma (HCC). This study investigated whether transient elastography (TE) can identify patients with subclinical cirrhosis (SCC) who are at increased risk of developing HCC among chronic hepatitis B (CHB) patients without clinical evidence of cirrhosis. A total of 2,876 CHB patients without clinical cirrhosis who received TE examinations between April 2006 and December 2012 were enrolled in this prospective study. SCC was defined as a nonclinical cirrhosis, but with a liver stiffness (LS) value ≥13 kilopascals (kPa). Mean age of the study population was 46.1 years, and male gender was predominant (n=1,775; 61.7%). Mean LS value was 7.9 kPa, and SCC was identified in 285 (9.9%) patients. During the median follow-up period of 48.9 months (range, 6.6-96.2), HCC developed in 16 patients (13.3 per 1,000 person-years) in the SCC group and 36 (3.4 per 1,000 person-years) in the non-SCC group. Cumulative incidence rate of HCC in the SCC group was significantly higher than that in the non-SCC group (P<0.001, log-rank test). On multivariate analysis, SCC was independently associated with a risk of developing HCC, regardless of antiviral therapy (without antiviral therapy: hazard ratio [HR]: 4.680; 95% confidence interval [CI]: 1.187-18.441; P=0.027; with antiviral therapy: HR, 3.344; 95% CI: 1.526-7.328; P=0.003). Conclusion: TE can identify CHB patients with SCC who are at increased risk of developing HCC, even when cirrhosis is not clinically apparent.

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