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Seo SI, Kim HS, Yang BK, Kang JG, Shin WG, Lee JH, Kim HY, Jang MK. Predictive factors for risk of hepatocellular carcinoma in immune inactive chronic hepatitis B. Clin Res Hepatol Gastroenterol 2020; 44:711-717. [PMID: 31959567 DOI: 10.1016/j.clinre.2019.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/01/2019] [Accepted: 10/12/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The risk factors for hepatocellular carcinoma (HCC) in immune inactive chronic hepatitis B (CHB) have not been clarified. The aim of this study was to investigate the predictive factors for HCC inimmune inactive CHB. METHODS A total of 337 patients in immune inactive CHB were consecutively enrolled in Kangdong Sacred Heart Hospital from 1995 to 2017. Univariate and multivariate analyses were performed to identify the independent risk factors for HCC development. RESULTS During the mean 63 months of follow-up, the incidence of HCC of study population was 4.5% (15/337). Patients who developed HCC were older, had more cirrhosis at baseline, and were more likely to experience ALT elevation>2 X upper limit of normal (ULN) during follow-up than those without HCC. In Cox regression analysis, increased ALT levels>2 X ULN during follow-up (hazard ratio [HR], 3.774; 95% confidence interval [CI], 1.145-12.443; P=0.029] and presence of cirrhosis (HR, 11.768; 95% CI, 3.350-41.336; P<0.001) were identified as the independent factors for HCC in immune inactive CHB. With increasing number of risk factors, the respective cumulative incidence of HCC at 10 years was 6.3%, 8.8%, and 63.5%. CONCLUSIONS Underlying cirrhosis and hepatic inflammation reflected by increased ALT levels>2 X ULN were significant predictors for HCC in immune inactive CHB. ALT elevation showed a synergistic effect in HCC development combined with cirrhosis. It suggests that patients with high serum ALT levels, especially those with cirrhosis, are required closer surveillance for HCC even in immune inactive CHB.
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Affiliation(s)
- Seung In Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Sungnae-gil, Kangdong-gu, Seoul, Republic of Korea 134-701
| | - Hyoung Su Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Sungnae-gil, Kangdong-gu, Seoul, Republic of Korea 134-701.
| | - Bo Kyung Yang
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Sungnae-gil, Kangdong-gu, Seoul, Republic of Korea 134-701
| | - Jin Gu Kang
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Sungnae-gil, Kangdong-gu, Seoul, Republic of Korea 134-701
| | - Woon Geon Shin
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Sungnae-gil, Kangdong-gu, Seoul, Republic of Korea 134-701
| | - Jin Heon Lee
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Sungnae-gil, Kangdong-gu, Seoul, Republic of Korea 134-701
| | - Hak Yang Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Sungnae-gil, Kangdong-gu, Seoul, Republic of Korea 134-701
| | - Myoung Kuk Jang
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Sungnae-gil, Kangdong-gu, Seoul, Republic of Korea 134-701
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