Analysis of hepatocellular carcinoma risk factors among patients with varying hepatitis B surface antigen status showed that higher BMI was a risk factor among those with HBsAg seroclearance compared with those with persistent HBsAg positivity.
“Hepatitis B surface antigen (HBsAg) seroclearance is considered to be one of the most important endpoints of chronic HBV infection and is associated with a reduced risk of HCC,” Ci Song, MD, from Nanjing Medical University in China, and colleagues wrote.
To evaluate the relationship between HBsAg status and HCC incidence, Song and colleagues conducted a population-based cohort study that included 652 patients with HBsAg seroclearance, 2,983 patients with persistent HBsAg and 33,920 patients who were negative for HBsAg.
Between April 2007 and November 2016, the researchers performed follow-up investigations every 6 months. The cumulative HCC incidence rate was 19.8 per 100,000 person-years. This was significantly lower than the rate in patients with persistent HBsAg (179.3 per 100,000 person-years; P < .001) and slightly higher than the rate in patients negative for HBsAg (6.81 per 100,000 person-years; P = .012).
Among patients with persistent HBsAg, men (HR = 2.83; 95% CI, 2.06-3.89), older patients (HR = 1.43; 95% CI, 1.08-1.9), those with a history of cancer (HR = 1.73; 95% CI 1.35-2.22), and those with alanine aminotransferase higher than 40 U/L (HR = 2.02; 95% CI, 1.14-2.89) or alpha-fetoprotein lower than 20 (HR = 10.92; 95% CI, 7.2-15.9) at baseline had significantly higher risk for HCC.
In contrast, the above predictors did not correlate with HCC risk in patients who achieved spontaneous HBsAg seroclearance. The factor associated with higher HCC risk in HBsAg seroclearance cases was BMI of 25 kg/m2 or higher (HR = 9.32; 95% CI, 1.11-78.08). Additionally, the incidence rate of fatty liver was higher in patients with HCC and HBsAg seroclearance compared with patients with HCC and persistent HBsAg (RR= 28.21; P = .049).
“Based on the above characteristic difference, we speculate that the carcinogenic mechanism among patients with HBsAg seroclearance was different from HBsAg-persistent carriers,” the researchers wrote. “For HBsAg-persistent carriers, HBV infection was the major driver factor of HCC. After HBsAg seroclearance, metabolic disease (obesity or fatty disease) may play a role in liver tumorigenesis.” – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures.