Milder liver cirrhosis and loss of serum HBeAg do not imply lower risk for hepatocellular carcinoma development in HBV-related cirrhosis
Jing Xu, Jian Shi, Yi-Ping Wang, Yong Lin, Yue-Xiang Chen, Jian Lu, Xin Zeng, Wei-Fen Xie
Med Sci Monit 2009; 15(6): CR274-279
Available online: 2009-05-29
Serum HBeAg status and liver cirrhosis severity at the time of diagnosis of hepatocellular carcinoma (HCC) in hepatitis B virus (HBV)-related cirrhosis remain inconclusive. The aim was to investigate the status of HBeAg and cirrhosis severity at the time of HCC development in the natural history of HBV-related cirrhosis in mainland China.
Material and Method: In a retrospective cross-sectional hospital-based setting, HBeAg status and severity of underlying cirrhosis, estimated by MELD (model for end-stage liver disease) scores and aspartate aminotransferase (AST)--to-platelet ratio index (APRI), were comprehensively compared in 377 HBsAg-positive compensated and decompensated liver cirrhosis and 434 with HCC patients to clarify the independent and joint effects of the factors.
Results: The majority (80.6%) of the HCC patients was negative for serum HBeAg. More than two-thirds of the patients with HCC had MELD scores <10. Severity of underlying liver cirrhosis and loss of serum HBeAg independently correlated with the risk of HCC development. Compared with the contrast group of HBeAg-positive patients with MELD scores > or =20, the odds ratio of HCC development in the patients with HBeAg negativity and MELD score <10 was 26.51 (95%CI: 8.98-78.28).
Conclusions: A large proportion of HBV-related cirrhotic patients had negative serum HBeAg and mild cirrhosis severity at the time of diagnosis of HCC.
Keywords: Regression Analysis, Precancerous Conditions - virology, Liver Neoplasms - virology, Liver Cirrhosis - virology, Hepatitis B virus - physiology, Hepatitis B e Antigens - blood, Carcinoma, Hepatocellular - virology, Aged, 80 and over, Adult, Adolescent, Risk Factors