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J Hepatol. 2015 Feb;62(2):363-70. doi: 10.1016/j.jhep.2014.08.045. Epub 2014 Sep 6.

Incidence and predictors of hepatocellular carcinoma in Caucasian chronic hepatitis B patients receiving entecavir or tenofovir.

Author information

1
Academic Department of Gastroenterology, Laiko General Hospital, Athens University Medical School, Athens, Greece; 2nd Department of Internal Medicine, Athens University Medical School, Hippokratio Hospital of Athens, Athens, Greece. Electronic address: gepapath@med.uoa.gr.
2
Department of Medicine and Research Laboratory of Internal Medicine, School of Medicine, University of Thessaly, Larissa, Greece.
3
Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey.
4
Hospital General Universitario Valle Hebron and Ciberehd, Barcelona, Spain.
5
Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, Thessaloniki, Greece.
6
Department of Gastroenterology & Hepatology, ErasmusMC, Rotterdam, The Netherlands.
7
Department of Hygiene, Epidemiology & Medical Statistics, Athens University Medical School, Athens, Greece.
8
2nd Department of Internal Medicine, Athens University Medical School, Hippokratio Hospital of Athens, Athens, Greece.
9
Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy.
10
Department of Gastroenterology & Hepatology, ErasmusMC, Rotterdam, The Netherlands; Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada.

Abstract

BACKGROUND & AIMS:

The risk of hepatocellular carcinoma (HCC) in Caucasian patients with chronic hepatitis B (CHB), treated with entecavir (ETV) or tenofovir (TDF), is unclear. We evaluated the incidence and predictors of HCC and the accuracy of existing HCC risk scores in Caucasian CHB patients receiving ETV/TDF.

METHODS:

This large, multicentre, retrospective cohort study included 1666 adult Caucasian CHB patients under ETV/TDF for 39 months. CHB without cirrhosis, compensated and decompensated cirrhosis were present in 67%, 39%, and 3% of patients, respectively. The predictability of baseline parameters and three risk scores (GAG-HCC, CU-HCC, and REACH-B), developed in Asian patients, was assessed.

RESULTS:

The cumulative probability of HCC was 1.3%, 3.4%, and 8.7% at year-1, year-3, and year-5 after ETV/TDF onset. Older age and lower platelets were strong independent HCC predictors in the total population and in the subgroups of cirrhotic and non-cirrhotic patients, while liver disease severity was an independent HCC predictor in the total population and in the cirrhotics. GAG-HCC, CU-HCC, and REACH-B risk scores were associated with HCC development only in the univariable but not in the multivariable analyses and offered poor to modest predictability.

CONCLUSIONS:

HCC can still develop in Caucasian CHB patients treated with ETV/TDF. Besides the well-known predictors of HCC, such as older age, male gender and more advanced liver disease, lower platelets represent an independent factor of higher HCC risk. The applicability and predictability of HCC risk scores developed in Asian patients are poor or modest in Caucasian CHB patients, for whom different risk scores are required.

KEYWORDS:

CU-HCC; Cirrhosis; Entecavir; GAG-HCC; Hepatitis B; Hepatocellular carcinoma; REACH-B; Risk scores; Tenofovir

PMID:
25195548
DOI:
10.1016/j.jhep.2014.08.045
[Indexed for MEDLINE]

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