Genotype C hepatitis B virus infection is associated with an increased risk of hepatocellular carcinoma

[Guest guest]

Gut 2004;53:1494-1498

© 2004 by BMJ Publishing Group Ltd & British Society of Gastroenterology

LIVER

Genotype C hepatitis B virus infection is associated with an increased risk

of hepatocellular carcinoma

H L-Y Chan, A Y Hui, M L Wong, A M-L Tse, L C-T Hung, V W-S Wong and J J-Y

Sung

Department of Medicine and Therapeutics, Chinese University of Hong Kong,

Hong Kong SAR, China

Correspondence to:

Dr H L-Y Chan

Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, 30-32

Ngan Shing St, Shatin, Hong Kong, China; hlychan@...

Background: Identification of risk factors for the development of

hepatocellular carcinoma (HCC) is important for HCC surveillance in chronic

hepatitis B virus (HBV) infection. Our aim was to study the independent risk

factors and effect of HBV genotypes on HCC development in a prospective

longitudinal cohort of chronic hepatitis B patients.

Patients and methods: Chronic hepatitis B patients recruited since 1997 were

prospectively followed up for the development of HCC. HCC was diagnosed by a

combination of fetoprotein, imaging, and histology. Liver cirrhosis was

defined as ultrasonic features of cirrhosis together with hypersplenism,

ascites, varices, and/or encephalopathy.

Results: In total, 426 patients were followed up for 1664 person years;

median 225 (range 12-295) weeks. Forty nine (11%) patients had underlying

clinical liver cirrhosis. A total of 242 (57%) and 179 (42%) patients had

HBV genotypes C and B, respectively. Twenty five patients developed HCC in a

median follow up of 121 (range 14-236) weeks. The overall incidence of HCC

was 1502 cases per 100 000 person years. On multivariate analysis, clinical

liver cirrhosis and HBV genotype C infection were independently associated

with HCC development, with an adjusted relative risk of 10.24 (95%

confidence interval (CI) 4.39-23.89; p<0.001) and 2.84 (95% CI 1.05-7.72; p

= 0.040), respectively. Patient age, sex, hepatitis B e antigen (HBeAg)

status, alanine aminotransferase (ALT) levels, and basal core promoter

mutations did not predict HCC development. Patients infected with HBV

genotype C tended to have persistently positive HBeAg or fluctuating HBeAg

status and higher ALT levels during the follow up period.

Conclusion: Genotype C HBV infection is an independent risk factor for HCC

development in addition to liver cirrhosis.

[Guest guest]

Gut 2004;53:1494-1498

© 2004 by BMJ Publishing Group Ltd & British Society of Gastroenterology

LIVER

Genotype C hepatitis B virus infection is associated with an increased risk

of hepatocellular carcinoma

H L-Y Chan, A Y Hui, M L Wong, A M-L Tse, L C-T Hung, V W-S Wong and J J-Y

Sung

Department of Medicine and Therapeutics, Chinese University of Hong Kong,

Hong Kong SAR, China

Correspondence to:

Dr H L-Y Chan

Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, 30-32

Ngan Shing St, Shatin, Hong Kong, China; hlychan@...

Background: Identification of risk factors for the development of

hepatocellular carcinoma (HCC) is important for HCC surveillance in chronic

hepatitis B virus (HBV) infection. Our aim was to study the independent risk

factors and effect of HBV genotypes on HCC development in a prospective

longitudinal cohort of chronic hepatitis B patients.

Patients and methods: Chronic hepatitis B patients recruited since 1997 were

prospectively followed up for the development of HCC. HCC was diagnosed by a

combination of fetoprotein, imaging, and histology. Liver cirrhosis was

defined as ultrasonic features of cirrhosis together with hypersplenism,

ascites, varices, and/or encephalopathy.

Results: In total, 426 patients were followed up for 1664 person years;

median 225 (range 12-295) weeks. Forty nine (11%) patients had underlying

clinical liver cirrhosis. A total of 242 (57%) and 179 (42%) patients had

HBV genotypes C and B, respectively. Twenty five patients developed HCC in a

median follow up of 121 (range 14-236) weeks. The overall incidence of HCC

was 1502 cases per 100 000 person years. On multivariate analysis, clinical

liver cirrhosis and HBV genotype C infection were independently associated

with HCC development, with an adjusted relative risk of 10.24 (95%

confidence interval (CI) 4.39-23.89; p<0.001) and 2.84 (95% CI 1.05-7.72; p

= 0.040), respectively. Patient age, sex, hepatitis B e antigen (HBeAg)

status, alanine aminotransferase (ALT) levels, and basal core promoter

mutations did not predict HCC development. Patients infected with HBV

genotype C tended to have persistently positive HBeAg or fluctuating HBeAg

status and higher ALT levels during the follow up period.

Conclusion: Genotype C HBV infection is an independent risk factor for HCC

development in addition to liver cirrhosis.

[Guest guest]

Gut 2004;53:1494-1498

© 2004 by BMJ Publishing Group Ltd & British Society of Gastroenterology

LIVER

Genotype C hepatitis B virus infection is associated with an increased risk

of hepatocellular carcinoma

H L-Y Chan, A Y Hui, M L Wong, A M-L Tse, L C-T Hung, V W-S Wong and J J-Y

Sung

Department of Medicine and Therapeutics, Chinese University of Hong Kong,

Hong Kong SAR, China

Correspondence to:

Dr H L-Y Chan

Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, 30-32

Ngan Shing St, Shatin, Hong Kong, China; hlychan@...

Background: Identification of risk factors for the development of

hepatocellular carcinoma (HCC) is important for HCC surveillance in chronic

hepatitis B virus (HBV) infection. Our aim was to study the independent risk

factors and effect of HBV genotypes on HCC development in a prospective

longitudinal cohort of chronic hepatitis B patients.

Patients and methods: Chronic hepatitis B patients recruited since 1997 were

prospectively followed up for the development of HCC. HCC was diagnosed by a

combination of fetoprotein, imaging, and histology. Liver cirrhosis was

defined as ultrasonic features of cirrhosis together with hypersplenism,

ascites, varices, and/or encephalopathy.

Results: In total, 426 patients were followed up for 1664 person years;

median 225 (range 12-295) weeks. Forty nine (11%) patients had underlying

clinical liver cirrhosis. A total of 242 (57%) and 179 (42%) patients had

HBV genotypes C and B, respectively. Twenty five patients developed HCC in a

median follow up of 121 (range 14-236) weeks. The overall incidence of HCC

was 1502 cases per 100 000 person years. On multivariate analysis, clinical

liver cirrhosis and HBV genotype C infection were independently associated

with HCC development, with an adjusted relative risk of 10.24 (95%

confidence interval (CI) 4.39-23.89; p<0.001) and 2.84 (95% CI 1.05-7.72; p

= 0.040), respectively. Patient age, sex, hepatitis B e antigen (HBeAg)

status, alanine aminotransferase (ALT) levels, and basal core promoter

mutations did not predict HCC development. Patients infected with HBV

genotype C tended to have persistently positive HBeAg or fluctuating HBeAg

status and higher ALT levels during the follow up period.

Conclusion: Genotype C HBV infection is an independent risk factor for HCC

development in addition to liver cirrhosis.

[Guest guest]

Gut 2004;53:1494-1498

© 2004 by BMJ Publishing Group Ltd & British Society of Gastroenterology

LIVER

Genotype C hepatitis B virus infection is associated with an increased risk

of hepatocellular carcinoma

H L-Y Chan, A Y Hui, M L Wong, A M-L Tse, L C-T Hung, V W-S Wong and J J-Y

Sung

Department of Medicine and Therapeutics, Chinese University of Hong Kong,

Hong Kong SAR, China

Correspondence to:

Dr H L-Y Chan

Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, 30-32

Ngan Shing St, Shatin, Hong Kong, China; hlychan@...

Background: Identification of risk factors for the development of

hepatocellular carcinoma (HCC) is important for HCC surveillance in chronic

hepatitis B virus (HBV) infection. Our aim was to study the independent risk

factors and effect of HBV genotypes on HCC development in a prospective

longitudinal cohort of chronic hepatitis B patients.

Patients and methods: Chronic hepatitis B patients recruited since 1997 were

prospectively followed up for the development of HCC. HCC was diagnosed by a

combination of fetoprotein, imaging, and histology. Liver cirrhosis was

defined as ultrasonic features of cirrhosis together with hypersplenism,

ascites, varices, and/or encephalopathy.

Results: In total, 426 patients were followed up for 1664 person years;

median 225 (range 12-295) weeks. Forty nine (11%) patients had underlying

clinical liver cirrhosis. A total of 242 (57%) and 179 (42%) patients had

HBV genotypes C and B, respectively. Twenty five patients developed HCC in a

median follow up of 121 (range 14-236) weeks. The overall incidence of HCC

was 1502 cases per 100 000 person years. On multivariate analysis, clinical

liver cirrhosis and HBV genotype C infection were independently associated

with HCC development, with an adjusted relative risk of 10.24 (95%

confidence interval (CI) 4.39-23.89; p<0.001) and 2.84 (95% CI 1.05-7.72; p

= 0.040), respectively. Patient age, sex, hepatitis B e antigen (HBeAg)

status, alanine aminotransferase (ALT) levels, and basal core promoter

mutations did not predict HCC development. Patients infected with HBV

genotype C tended to have persistently positive HBeAg or fluctuating HBeAg

status and higher ALT levels during the follow up period.

Conclusion: Genotype C HBV infection is an independent risk factor for HCC

development in addition to liver cirrhosis.