학술논문
Role of Early On-Treatment Serum HBV RNA Declines in Predicting Hepatocellular Carcinoma Risk in Patients With Chronic Hepatitis B
Document Type
Article
Author
Liu, Shi ; Wong, Grace Lai-Hung ; Fan, Rong ; Niu, Junqi ; Ma, Hong ; Liang, Wanying ; Lu, Xingyu ; Xie, Jianping ; Shang, Jia ; Xie, Dongying ; Liu, Yali ; Zhou, Bin ; Xie, Qing ; Peng, Jie ; Gao, Hongbo ; Rao, Huiying ; Chen, Jinjun ; Sheng, Jifang ; Shen, Sheng ; Yang, Song ; Dou, Xiaoguang ; Zhang, Zhengang ; Wong, Vincent Wai-Sun ; Hou, Jinlin ; Sun, Jian
Source
In Clinical Gastroenterology and Hepatology
Subject
Language
ISSN
1542-3565
Abstract
Background and Aims Hepatocellular carcinoma (HCC) risk prediction models established in patients with chronic hepatitis B receiving a nucleos(t)ide analogue (NA) rarely include viral factors because of mediocre predictability of traditional viral markers. Here, we investigate the role of serum hepatitis B virus (HBV) RNA, a novel biomarker, in predicting HCC risk in NA-treated patients.Methods A total of 1374 NA-treated patients were enrolled from 2 prospective chronic hepatitis B cohorts. Serum HBV RNA was detected at baseline, year 1, 2 and 3 of treatment. Cox proportional-hazard model was used to investigate the association of HBV RNA kinetics with HCC risk.Results After a median follow-up of 5.4 years, 76 patients developed HCC. HBV RNA declines at year 1 (adjusted hazard ratio, 0.70, P = .009) and 2 (adjusted hazard ratio, 0.71; P = .016) were independently associated with HCC risk. Patients with less HBV RNA decline at year 1 (≤0.4 log10 copies/mL) or 2 (≤0.6 log10 copies/mL) had 2.22- and 2.09-folds higher HCC risk, respectively, than those with more declines. When incorporating these early on-treatment HBV RNA declines into existing HCC risk scores, including PAGE-B (age, sex, and platelets), modified PAGE-B (mPAGE-B) (age, sex, platelets, and albumin), and aMAP (age, sex, platelets, and albumin-bilirubin score) score, they could enhance their predictive performance (ie, C-index 0.814 vs 0.78 [model (PAGE-B + year-1 HBV RNA decline) vs PAGE-B score based on baseline parameters]).Conclusions Serum HBV RNA declines at year 1 and 2 were significantly associated with on-treatment HCC risk. Incorporating early on-treatment HBV RNA declines into HCC risk prediction models can be useful tools to guide appropriate surveillance strategies in NA-treated patients.