Hepatocellular Carcinoma Risk of Compensated Cirrhosis Patients with Elevated HBV DNA Levels according to Serum Aminotransferase Levels.
10.3346/jkms.2015.30.11.1618
- Author:
Junggyu LEE
1
;
Dong Hyun SINN
;
Jung Hee KIM
;
Geum Youn GWAK
;
Hye Seung KIM
;
Sin Ho JUNG
;
Yong Han PAIK
;
Moon Seok CHOI
;
Joon Hyeok LEE
;
Kwang Cheol KOH
;
Byung Chul YOO
;
Seung Woon PAIK
Author Information
1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. sw.paik@samsung.com
- Publication Type:Original Article
- Keywords:
Liver Neoplasms;
Antiviral Therapy;
Aminotransferase;
Treatment;
Viruses
- MeSH:
Alanine Transaminase/*blood;
Biomarkers/blood;
Carcinoma, Hepatocellular/*blood/*epidemiology;
Causality;
Comorbidity;
DNA, Viral/blood;
Female;
Hepatitis B/blood/*epidemiology;
Hepatitis B virus/genetics;
Humans;
Incidence;
Liver Cirrhosis/blood/drug therapy/epidemiology;
Liver Neoplasms/*blood/*epidemiology;
Male;
Middle Aged;
Reproducibility of Results;
Republic of Korea/epidemiology;
Risk Factors;
Sensitivity and Specificity
- From:Journal of Korean Medical Science
2015;30(11):1618-1624
- CountryRepublic of Korea
- Language:English
-
Abstract:
Sometimes, hepatitis B virus (HBV)-related cirrhotic patients with normal aminotransferase levels are closely followed-up for the elevation of aminotransferase levels instead of prompt antiviral therapy (AVT). We analyzed the long-term hepatocellular carcinoma (HCC) risk according to the aminotransferase levels in a retrospective cohort of 1,468 treatment-naive, HBV-related, compensated cirrhosis patients with elevated HBV DNA levels (> or =2,000 IU/mL). Based on aminotransferase levels, patients were categorized into normal (< 40 U/L, n = 364) and elevated group (> or =40 U/L, n = 1,104). During a median of 5.3 yr of follow-up (range: 1.0-8.2 yr), HCC developed in 296 (20%) patients. The 5-yr cumulative HCC incidence rate was higher in patients with elevated aminotransferase level, but was not low in normal aminotransferase level (17% vs. 14%, P = 0.004). During the follow-up, 270/364 (74%) patients with normal aminotransferase levels experienced elevation of aminotransferase levels, and AVT was initiated in 1,258 (86%) patients. Less patients with normal aminotransferase levels received AVT (70% vs. 91%, P < 0.001) and median time to start AVT was longer (17.9 vs. 2.4 months, P < 0.001). AVT duration was an independent factor associated with HCC, and median duration of AVT was shorter (4.0 vs. 2.6 yr, P < 0.001) in patients with normal aminotransferase levels. The HCC risk of compensated cirrhosis patients with normal aminotransferase level is not low, and AVT duration is associated with lowered HCC risk, indicating that prompt AVT should be strongly considered even for those with normal aminotransferase levels.
