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High percentage atypical hepatocellular carcinoma in chronic hepatitis B patients treated with nucleos(t)ide analogs.
Lin, Ching-Chung; Bair, Ming-Jong; Liu, Chia-Yuan; Lin, Ze-Yu; Chen, Chih-Jen; Chen, Ming-Jen; Chu, Cheng-Hsin; Wang, Horng-Yuan; Shih, Shou-Chuan; Wang, Tsang-En.
Affiliation
  • Lin CC; Mackay Medical College, New Taipei City.
  • Bair MJ; Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei.
  • Liu CY; Mackay Medical College, New Taipei City.
  • Lin ZY; Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung, Taiwan.
  • Chen CJ; Mackay Medical College, New Taipei City.
  • Chen MJ; Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei.
  • Chu CH; Mackay Medical College, New Taipei City.
  • Wang HY; Mackay Medical College, New Taipei City.
  • Shih SC; Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei.
  • Wang TE; Mackay Medical College, New Taipei City.
Medicine (Baltimore) ; 98(1): e13818, 2019 Jan.
Article in En | MEDLINE | ID: mdl-30608393
Nucleos(t)ide analogs are used for preventing liver cirrhosis in chronic hepatitis B patients, but the risk factors of hepatocellular carcinoma (HCC) in these patients remain unclear. We designed this retrospective cohort study, the aim is to determine the risk factors for HCC development and its image presentation under nucleos(t)ide analogs treatment.In this study, patients were treated with lamivudine (LAM), entecavir 0.5 mg (ETV), or telbivudine (LdT), and followed-up for at least 2 years to detect HCC and its presentation. Assessment of the risk factors for HCC included age, sex, HBeAg, viral load, liver cirrhosis, current and previous medications, and liver function tests.Totally, 396 patients were recruited, and 18 patients developed HCC. The mean time from the treatment to HCC development was 28.5 ±â€Š16.7 months. The clinical characteristics in HCC and no-HCC groups showed significant differences among age (52.8 ±â€Š6.1 vs 47.1 ±â€Š12.6 years, P <.01), baseline alanine transaminase (ALT) levels (161.4 ±â€Š177.3 vs 361.7 ±â€Š496.3, P <.01), and baseline liver cirrhosis (72.2% vs 29.9%, P <.01). In patients aged ≥45 years, the hazard ratio of HCC was 10.2 and liver cirrhosis was 4.1. Majority of HCCs developed in the right liver (14/18), were single numbered (13/18), had tumor size about 1.9 ±â€Š0.7 cm, were classified as T1 (14/18, TNM staging), and the atypical image occupied 88% of the HCC cases.The patients aged ≧45 years on long-term nucleos(t)ide analog therapy, and with baseline liver cirrhosis were at a high risk of HCC. Regular alpha-fetoprotein (AFP) assessment and image study of these patients are the gold standards for early HCC detection in patients with high percentage atypical HCC appearances.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Antiviral Agents / Carcinoma, Hepatocellular / Hepatitis B, Chronic / Liver Neoplasms / Nucleosides Type of study: Diagnostic_studies / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limits: Adult / Female / Humans / Male / Middle aged Language: En Journal: Medicine (Baltimore) Year: 2019 Document type: Article Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Antiviral Agents / Carcinoma, Hepatocellular / Hepatitis B, Chronic / Liver Neoplasms / Nucleosides Type of study: Diagnostic_studies / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limits: Adult / Female / Humans / Male / Middle aged Language: En Journal: Medicine (Baltimore) Year: 2019 Document type: Article Country of publication: