Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
J Hepatol. 2017 Nov;67(5):902-908. doi: 10.1016/j.jhep.2017.06.019. Epub 2017 Jun 24.
Previous studies suggested spontaneous seroclearance of hepatitis B surface antigen (HBsAg) was still associated with an increased risk of hepatocellular carcinoma (HCC), in patients ⩾50years of age. This study aimed to evaluate the risk of HCC after HBsAg seroclearance and the impact of gender on HCC.
All chronic hepatitis B patients under medical care in Hospital Authority, Hong Kong who had cleared HBsAg between January 2000 and August 2016 were identified. The age of the patient at HBsAg seroclearance, gender, and subsequent development of HCC were analyzed.
A total of 4,568 patients with HBsAg seroclearance were identified; 793 (17.4%) were treated by nucleos(t)ide analogues and 60 (1.3%) had received interferon treatment. At a median (interquartile range) follow-up of 3.4 (1.5-5.0)years, 54 patients developed HCC; cumulative incidences of HCC at 1, 3 and 5years were 0.9%, 1.3% and 1.5%, respectively. Age above 50years (adjusted hazard ratio 4.31, 95% confidence interval 1.72-10.84; p=0.002) and male gender (2.47, 1.24-4.91; p=0.01) were two independent risk factors of HCC. Female patients aged ⩽50years (n=545) had zero risk of HCC within 5years of follow-up. Male patients aged ⩽50years (n=769), female patients aged >50years (n=1,149) and male patients aged >50years (n=2,105) had a 5-year cumulative incidence of HCC 0.7%, 1.0% and 2.5%, respectively. Similar findings were observed in patients with spontaneous and antiviral treatment-induced HBsAg seroclearance.
Female patients aged 50years or below have zero risk of HCC after HBsAg seroclearance, whereas female patients aged above 50years and all male patients are still at risk of HCC. Lay summary: We investigated 4,568 patients with hepatitis B surface antigen (HBsAg) seroclearance. Female patients aged 50years or below have zero risk of hepatocellular carcinoma (HCC) after HBsAg seroclearance, whereas female patients aged above 50years and all male patients are still at risk of HCC.
先前的研究表明，乙型肝炎表面抗原（HBsAg）自发清除后仍与肝细胞癌（HCC）风险增加相关，尤其在年龄 ⩾50 岁的患者中。本研究旨在评估 HBsAg 清除后 HCC 的风险，以及性别对 HCC 的影响。
在香港医管局接受治疗的所有慢性乙型肝炎患者中，确定了在 2000 年 1 月至 2016 年 8 月期间清除 HBsAg 的患者。分析了患者在 HBsAg 清除时的年龄、性别以及随后 HCC 的发展情况。
共确定了 4568 例 HBsAg 清除患者；793 例（17.4%）接受了核苷（酸）类似物治疗，60 例（1.3%）接受了干扰素治疗。中位（四分位间距）随访 3.4（1.5-5.0）年后，54 例患者发生 HCC；1、3 和 5 年 HCC 的累积发生率分别为 0.9%、1.3%和 1.5%。年龄 ⩾50 岁（调整后的危险比 4.31，95%置信区间 1.72-10.84；p=0.002）和男性（2.47，1.24-4.91；p=0.01）是 HCC 的两个独立危险因素。年龄 ⩽50 岁的女性患者（n=545）在 5 年随访期间 HCC 风险为零。年龄 ⩽50 岁的男性患者（n=769）、年龄 ⩾50 岁的女性患者（n=1149）和年龄 ⩾50 岁的男性患者（n=2105）5 年 HCC 的累积发生率分别为 0.7%、1.0%和 2.5%。在自发性和抗病毒治疗诱导的 HBsAg 清除患者中也观察到了类似的发现。
年龄 ⩽50 岁的女性患者 HBsAg 清除后 HCC 风险为零，而年龄 ⩾50 岁的女性患者和所有男性患者仍有 HCC 风险。
