Older people who are functionally cured of hepatitis B are at a significantly higher risk for hepatocellular carcinoma, a new study warns.
Even after the seroclearance of hepatitis B surface antigen, "there is still risk of developing hepatocellular carcinoma," particularly when clearance occurs after the age of 50, said Henry Chan, MD, director of the Institute of Digestive Disease at The Chinese University of Hong Kong.
Previous studies have demonstrated that patients in this age group who spontaneously experience seroclearance are at increased risk for hepatocellular carcinoma, he explained here at the International Liver Congress 2017. However, small cohort sizes and low event rates have limited clinical interpretation of the findings.
Confirmation of this risk could lead to closer cancer surveillance for this subgroup of patients, Dr Chan told Medscape Medical News.
Dr Chan and his colleagues assessed people with chronic hepatitis B who experienced seroclearance from January 2000 to August 2016. Mean follow-up was 3.7 years.
The team determined time of seroclearance and the subsequent development of hepatocellular carcinoma from the Clinical Data Analysis and Reporting System, a database of patients treated in Hong Kong's public healthcare system.
Of the 5181 patients identified, 3548 (69%) experienced hepatitis B surface antigen clearance after the age of 50.
In the study cohort, most of the 67 patients who developed hepatocellular carcinoma were men older than 50 years.
Table. Cumulative Incidence of Hepatocellular Carcinoma After Hep B Clearance
|Subgroup||Year 1, %||Year 3, %||Year 5, %|
|Young women (≤50 years)||0.2||0.2||0.2|
|Young men (≤50 years)||0.5||0.6||0.8|
|Older women (>50 years)||1.1||1.3||1.3|
|Older men (>50 years)||1.4||2.1||2.5|
To understand why risk is higher in men who experience seroclearance after the age of 50, the researchers looked at clinical variables.
"We found, in general, that these patients tend have more advanced disease, including slightly lower albumin levels, slightly higher bilirubin levels, and slightly higher ALT levels, at a time when they are losing their antigen," Dr Chan explained. "So some of these patients probably have already suffered some liver damage before they lose S-antigen."
These data are "very good quality," and the results of this study are "reassuring," said session moderator Bruno Sangro, MD, from the Clinica Universidad de Navarra in Madrid.
"The risk of hepatocellular carcinoma is driven by the presence of cirrhosis or the presence of chronic hepatitis B infection, but that is moderated very intensely by age and gender. We know that, so this is not a surprise," he told Medscape Medical News.
"What is interesting is that there is a subpopulation of older, male patients in which the risk is greater. The practical approach is that these patients should be kept on surveillance, at least for some years," he explained.
Patients in the other risk groups should probably be followed for some time as well, but men older than 50 should be followed "for sure," Dr Sangro said.
Dr Chang and Dr Sangro have disclosed no relevant financial relationships.
International Liver Congress (ILC) 2017: Abstract PS-106. Presented April 20, 2017.