Predictors of failure to detect early hepatocellular carcinoma in patients with chronic hepatitis B who received regular surveillance

Y. E. Chon, K. S. Jung, M. J. Kim, J. Y. Choi, C. An, J. Y. Park, S. H. Ahn, B. K. Kim, S. U. Kim, H. Park, S. K. Hwang, K. S. Rim, K. H. Han, D. Y. Kim

Research output: Contribution to journalArticle

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Abstract

Background: A proportion of chronic hepatitis B (CHB) patients are diagnosed with advanced hepatocellular carcinoma (HCC) despite regular surveillance. Aims: To determine predictors for HCC detection failure in CHB patients who underwent regular surveillance. Methods: CHB patients with well-preserved liver function, who underwent ultrasonography and alpha-foetoprotein (AFP) analysis every 6 months, were enrolled. Cox regression analysis was used to identify predictors for detection failure, defined as HCC initially diagnosed at Barcelona Clinic Liver Cancer (BCLC) stage B or C. Results: Of the 4590 CHB patients (mean age, 52.1 years; men, 61.6%), 169 patients were diagnosed with HCC (3.68%) and 35 (20.7%) HCC patients were initially diagnosed with HCC BCLC stage B or C. The cumulative incidence of HCC detection failure was 0.2% at year 1 and 1.3% at year 5. Multivariate analyses indicated that cirrhosis (hazard ratio [HR], 3.078; 95% CI, 1.389-6.821; P = 0.006), AFP levels ≥9 ng/mL (HR, 5.235; 95% CI, 2.307-11.957; P = 0.010), and diabetes mellitus (HR, 3.336; 95% CI, 1.341-8.296; P = 0.010) were independent predictors of HCC detection failure. Another model that incorporated liver stiffness (LS) values identified LS values ≥11.7 kPa (HR, 11.045; 95% CI, 2.066-59.037; P = 0.005) and AFP levels ≥9 ng/mL (HR, 4.802; 95% CI, 1.613-14.297; P = 0.005) as predictors of detection failure. Conclusions: In CHB patients undergoing regular surveillance with ultrasonography and alpha-foetoprotein (AFP) analysis every 6 months, the HCC detection failure rate was not high (0.8% per person; 0.1% per test). However, careful attention should be paid in patients with advanced liver fibrosis (clinical cirrhosis or LS value >11.7 kPa), high AFP levels, or diabetes mellitus, who are prone to surveillance failure.

Original languageEnglish
Pages (from-to)1201-1212
Number of pages12
JournalAlimentary Pharmacology and Therapeutics
Volume47
Issue number8
DOIs
Publication statusPublished - 2018 Apr

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Chronic Hepatitis B
Hepatocellular Carcinoma
alpha-Fetoproteins
Liver Neoplasms
Liver Cirrhosis
Liver
Ultrasonography
Diabetes Mellitus
Fibrosis
Multivariate Analysis
Regression Analysis
Incidence

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

Cite this

Chon, Y. E. ; Jung, K. S. ; Kim, M. J. ; Choi, J. Y. ; An, C. ; Park, J. Y. ; Ahn, S. H. ; Kim, B. K. ; Kim, S. U. ; Park, H. ; Hwang, S. K. ; Rim, K. S. ; Han, K. H. ; Kim, D. Y. / Predictors of failure to detect early hepatocellular carcinoma in patients with chronic hepatitis B who received regular surveillance. In: Alimentary Pharmacology and Therapeutics. 2018 ; Vol. 47, No. 8. pp. 1201-1212.
@article{ee8ce487e1524e2780dab9ee52d92aef,
title = "Predictors of failure to detect early hepatocellular carcinoma in patients with chronic hepatitis B who received regular surveillance",
abstract = "Background: A proportion of chronic hepatitis B (CHB) patients are diagnosed with advanced hepatocellular carcinoma (HCC) despite regular surveillance. Aims: To determine predictors for HCC detection failure in CHB patients who underwent regular surveillance. Methods: CHB patients with well-preserved liver function, who underwent ultrasonography and alpha-foetoprotein (AFP) analysis every 6 months, were enrolled. Cox regression analysis was used to identify predictors for detection failure, defined as HCC initially diagnosed at Barcelona Clinic Liver Cancer (BCLC) stage B or C. Results: Of the 4590 CHB patients (mean age, 52.1 years; men, 61.6{\%}), 169 patients were diagnosed with HCC (3.68{\%}) and 35 (20.7{\%}) HCC patients were initially diagnosed with HCC BCLC stage B or C. The cumulative incidence of HCC detection failure was 0.2{\%} at year 1 and 1.3{\%} at year 5. Multivariate analyses indicated that cirrhosis (hazard ratio [HR], 3.078; 95{\%} CI, 1.389-6.821; P = 0.006), AFP levels ≥9 ng/mL (HR, 5.235; 95{\%} CI, 2.307-11.957; P = 0.010), and diabetes mellitus (HR, 3.336; 95{\%} CI, 1.341-8.296; P = 0.010) were independent predictors of HCC detection failure. Another model that incorporated liver stiffness (LS) values identified LS values ≥11.7 kPa (HR, 11.045; 95{\%} CI, 2.066-59.037; P = 0.005) and AFP levels ≥9 ng/mL (HR, 4.802; 95{\%} CI, 1.613-14.297; P = 0.005) as predictors of detection failure. Conclusions: In CHB patients undergoing regular surveillance with ultrasonography and alpha-foetoprotein (AFP) analysis every 6 months, the HCC detection failure rate was not high (0.8{\%} per person; 0.1{\%} per test). However, careful attention should be paid in patients with advanced liver fibrosis (clinical cirrhosis or LS value >11.7 kPa), high AFP levels, or diabetes mellitus, who are prone to surveillance failure.",
author = "Chon, {Y. E.} and Jung, {K. S.} and Kim, {M. J.} and Choi, {J. Y.} and C. An and Park, {J. Y.} and Ahn, {S. H.} and Kim, {B. K.} and Kim, {S. U.} and H. Park and Hwang, {S. K.} and Rim, {K. S.} and Han, {K. H.} and Kim, {D. Y.}",
year = "2018",
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language = "English",
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Predictors of failure to detect early hepatocellular carcinoma in patients with chronic hepatitis B who received regular surveillance. / Chon, Y. E.; Jung, K. S.; Kim, M. J.; Choi, J. Y.; An, C.; Park, J. Y.; Ahn, S. H.; Kim, B. K.; Kim, S. U.; Park, H.; Hwang, S. K.; Rim, K. S.; Han, K. H.; Kim, D. Y.

In: Alimentary Pharmacology and Therapeutics, Vol. 47, No. 8, 04.2018, p. 1201-1212.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictors of failure to detect early hepatocellular carcinoma in patients with chronic hepatitis B who received regular surveillance

AU - Chon, Y. E.

AU - Jung, K. S.

AU - Kim, M. J.

AU - Choi, J. Y.

AU - An, C.

AU - Park, J. Y.

AU - Ahn, S. H.

AU - Kim, B. K.

AU - Kim, S. U.

AU - Park, H.

AU - Hwang, S. K.

AU - Rim, K. S.

AU - Han, K. H.

AU - Kim, D. Y.

PY - 2018/4

Y1 - 2018/4

N2 - Background: A proportion of chronic hepatitis B (CHB) patients are diagnosed with advanced hepatocellular carcinoma (HCC) despite regular surveillance. Aims: To determine predictors for HCC detection failure in CHB patients who underwent regular surveillance. Methods: CHB patients with well-preserved liver function, who underwent ultrasonography and alpha-foetoprotein (AFP) analysis every 6 months, were enrolled. Cox regression analysis was used to identify predictors for detection failure, defined as HCC initially diagnosed at Barcelona Clinic Liver Cancer (BCLC) stage B or C. Results: Of the 4590 CHB patients (mean age, 52.1 years; men, 61.6%), 169 patients were diagnosed with HCC (3.68%) and 35 (20.7%) HCC patients were initially diagnosed with HCC BCLC stage B or C. The cumulative incidence of HCC detection failure was 0.2% at year 1 and 1.3% at year 5. Multivariate analyses indicated that cirrhosis (hazard ratio [HR], 3.078; 95% CI, 1.389-6.821; P = 0.006), AFP levels ≥9 ng/mL (HR, 5.235; 95% CI, 2.307-11.957; P = 0.010), and diabetes mellitus (HR, 3.336; 95% CI, 1.341-8.296; P = 0.010) were independent predictors of HCC detection failure. Another model that incorporated liver stiffness (LS) values identified LS values ≥11.7 kPa (HR, 11.045; 95% CI, 2.066-59.037; P = 0.005) and AFP levels ≥9 ng/mL (HR, 4.802; 95% CI, 1.613-14.297; P = 0.005) as predictors of detection failure. Conclusions: In CHB patients undergoing regular surveillance with ultrasonography and alpha-foetoprotein (AFP) analysis every 6 months, the HCC detection failure rate was not high (0.8% per person; 0.1% per test). However, careful attention should be paid in patients with advanced liver fibrosis (clinical cirrhosis or LS value >11.7 kPa), high AFP levels, or diabetes mellitus, who are prone to surveillance failure.

AB - Background: A proportion of chronic hepatitis B (CHB) patients are diagnosed with advanced hepatocellular carcinoma (HCC) despite regular surveillance. Aims: To determine predictors for HCC detection failure in CHB patients who underwent regular surveillance. Methods: CHB patients with well-preserved liver function, who underwent ultrasonography and alpha-foetoprotein (AFP) analysis every 6 months, were enrolled. Cox regression analysis was used to identify predictors for detection failure, defined as HCC initially diagnosed at Barcelona Clinic Liver Cancer (BCLC) stage B or C. Results: Of the 4590 CHB patients (mean age, 52.1 years; men, 61.6%), 169 patients were diagnosed with HCC (3.68%) and 35 (20.7%) HCC patients were initially diagnosed with HCC BCLC stage B or C. The cumulative incidence of HCC detection failure was 0.2% at year 1 and 1.3% at year 5. Multivariate analyses indicated that cirrhosis (hazard ratio [HR], 3.078; 95% CI, 1.389-6.821; P = 0.006), AFP levels ≥9 ng/mL (HR, 5.235; 95% CI, 2.307-11.957; P = 0.010), and diabetes mellitus (HR, 3.336; 95% CI, 1.341-8.296; P = 0.010) were independent predictors of HCC detection failure. Another model that incorporated liver stiffness (LS) values identified LS values ≥11.7 kPa (HR, 11.045; 95% CI, 2.066-59.037; P = 0.005) and AFP levels ≥9 ng/mL (HR, 4.802; 95% CI, 1.613-14.297; P = 0.005) as predictors of detection failure. Conclusions: In CHB patients undergoing regular surveillance with ultrasonography and alpha-foetoprotein (AFP) analysis every 6 months, the HCC detection failure rate was not high (0.8% per person; 0.1% per test). However, careful attention should be paid in patients with advanced liver fibrosis (clinical cirrhosis or LS value >11.7 kPa), high AFP levels, or diabetes mellitus, who are prone to surveillance failure.

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