Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
Faculty of Medicine, Cairo University, Cairo, Egypt.
Rev Med Virol. 2022 Nov;32(6):e2353. doi: 10.1002/rmv.2353. Epub 2022 Apr 20.
Chronic hepatitis B (CHB) infection is a risk factor for hepatocellular carcinoma (HCC). Previous studies showed that elevated levels of Hepatitis B Virus (HBV) DNA and HBsAg are associated with increased HCC risk in patients with chronic HBV infection. Multiple studies showed that high levels of HBV DNA and Hepatitis B Surface Antigen (HBsAg) are associated with higher HCC risk in CHB patients. Patients treated with antiviral therapy may have undetectable or low levels of HBV DNA and HBsAg loss. However, HCC may develop in some patients with low-level HBV DNA and HBsAg seroconversion. In this study, we evaluated the role of HBcrAg in predicting HBV related HCC development. We searched PubMed, Scopus, and Web of Science databases using keywords (hepatitis B core-related antigen, hepatocellular carcinoma, liver neoplasm, hepatocellular and hepatic cancer, to identify studies assessing serum level of HBcrAg in patients with CHB and HCC. The search resulted in 184 studies. Seven studies were included: Four of which were retrospective cohort studies, and the rest were prospective cohort, case controls. Six of them reported a higher HBcrAg positivity rate in the HCC group when compared with the HBV DNA assay, yet with similar hazard ratio (HR) in predicting the incidence of HCC. However, four studies found that HBcrAg positivity was an independent risk factor for HCC development with a HR ranging from 3.27 to 7.05. HBV-related HCC has many proposed biomarkers in its prediction, yet our findings revealed HBcrAg to may have superiority over other biomarkers. High quality studies with bigger sample size research is needed to understand the potential role of HBcrAg in CHB induced HCC.
慢性乙型肝炎（CHB）感染是肝细胞癌（HCC）的一个危险因素。先前的研究表明，乙型肝炎病毒（HBV）DNA 和 HBsAg 水平升高与慢性 HBV 感染患者 HCC 风险增加相关。多项研究表明，HBV DNA 和乙型肝炎表面抗原（HBsAg）水平升高与 CHB 患者 HCC 风险增加相关。接受抗病毒治疗的患者可能会出现 HBV DNA 和 HBsAg 无法检测或低水平丢失。然而，一些低水平 HBV DNA 和 HBsAg 血清学转换的患者可能会发展为 HCC。在这项研究中，我们评估了 HBcrAg 在预测 HBV 相关 HCC 发展中的作用。我们使用关键词（乙型肝炎核心相关抗原、肝细胞癌、肝肿瘤、肝细胞和肝肿瘤）在 PubMed、Scopus 和 Web of Science 数据库中进行了搜索，以确定评估 CHB 和 HCC 患者血清 HBcrAg 水平的研究。搜索结果为 184 项研究。有 7 项研究入选：其中 4 项为回顾性队列研究，其余为前瞻性队列、病例对照研究。其中 6 项研究报告 HCC 组的 HBcrAg 阳性率高于 HBV DNA 检测，但在预测 HCC 发生率方面具有相似的风险比（HR）。然而，有 4 项研究发现 HBcrAg 阳性是 HCC 发展的独立危险因素，HR 范围为 3.27 至 7.05。HBV 相关 HCC 的预测有许多提出的生物标志物，但我们的研究结果表明 HBcrAg 可能优于其他标志物。需要进行高质量、大样本量的研究，以了解 HBcrAg 在 CHB 诱导 HCC 中的潜在作用。
