Incidence and Characteristic of Hepatocellular Carcinoma in Hepatitis B Related Cirrhosis

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND Background: Hepatocellular carcinoma (HCC) and liver decompensation are the serious complications of chronic hepatitis B (CHB) especially after development of cirrhosis. Current treatment of CHB is nucleos(t)ide analogues (NA). Objective: To evaluate the incidence and characteristic of HCC in patients with HBV cirrhosis as well as the rate of hepatic decompensation in NA treated CHB. Materials and Methods: A retrospective chart review of the patients with HBV associated cirrhosis who had attended Hepatitis Clinic, Siriraj Hospital between December 1, 2010 to December 31, 2011 was conducted. The hospital charts were reviewed to capture HBV related treatment, cirrhotic complication, occurrence, and characteristic of HCC. Results: There were 241 HBV related compensated cirrhosis enrolled in the study. Among these, 234 patients received NA treatment. There were 29 (12%) patients developed HCC during a median follow-up of 4.6 years and the incidence rates of HCC per 100 person-year was 2.6. There was no risk factor that predicted the occurrence of HCC, however, from multivariate analysis, older age, male gender, diabetes mellitus, HBeAg positive, alpha-fetoprotein (AFP) >10 IU/mL and HBV DNA >2,000 IU/ml at baseline trended to have a higher risk of HCC but did not reach statistical significance. Most HCCs found in the present study were asymptomatic and were found during surveillance and were single lesion located in the right lobe without portal involvement. Most of the HCC patients received potentially curative treatment (37.9%). Moreover, we found that the incidence of liver decompensation was 0.53 per 100 person-year. Two HCC patients died because of progressive liver disease. Conclusion: HCC is among the most serious complication of HBV related cirrhosis and occurred 2.6 per 100 person-year in the present study. It is unclear whether treatment would reduce HCC since most of the patients received treatment. Liver decompensation was found at 0.53 per 100 person-year which is lower than previous report.