On-Treatment Changes in FIB-4 and 1-Year FIB-4 Values Help Identify Patients with Chronic Hepatitis B Receiving Entecavir Therapy Who Have the Lowest Risk of Hepatocellular Carcinoma.

Hung-Wei Wang,Po-Heng Chuang,Chia-Hsin Lin,Mei-Hsuan Lee,Hsueh-Chou Lai,Tsung-Hui Hu,Jing-Houng Wang,Chien-Hung Chen,Cheng-Yuan Peng,Wen-Pang Su,Sheng-Nan Lu,Chao-Hung Hung

doi:10.3390/cancers12051177

Abstract

Noninvasive fibrosis indices can help stratify the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) receiving nucleos(t)ide analogue (NA) therapy. We investigated the predictive performance of on-treatment changes in FIB-4 (△FIB-4) and 1-year FIB-4 values (FIB-4 12M) for HCC risk in patients with CHB receiving entecavir therapy. We included 1325 NA-naïve patients with CHB treated with entecavir, retrospectively, from January 2007 to August 2012. A combination of △FIB-4 and FIB-4 12M was used to stratify the cumulative risk of HCC into three subgroups each in the noncirrhotic and cirrhotic subgroups with p < 0.0001 by using the log-rank test (noncirrhotic: the highest risk (n = 88): FIB-4 12M ≥ 1.58/△FIB-4 ≥ 0 (hazard ratio (HR): 40.35; 95% confidence interval (CI): 5.107–318.7; p <0.0001) and cirrhotic: the highest risk (n = 89): FIB-4 12M ≥2.88/△FIB-4 ≥0 (HR: 9.576; 95% CI: 5.033–18.22; p < 0.0001)). Patients with noncirrhotic CHB treated with entecavir who had a FIB-4 12M < 1.58 or FIB-4 12M ≥ 1.58/△FIB-4 < 0 exhibited the lowest 5-year HCC risk (0.6%). A combination of on-treatment changes in FIB-4 and 1-year FIB-4 values may help identify patients with CHB receiving entecavir therapy with the lowest risk of HCC.

Highlights

Liver cirrhosis and hepatocellular carcinoma (HCC) are the major complications of chronic hepatitis B (CHB) [1]
We summarise the predictive algorithm for risk in the patients with treated with w
Another study in Caucasian CHB patients treated with entecavir or tenofovir for a median duration of 39 months revealed that the cumulative incidences of HCC after 5 years of treatment were 3.7% and 17.5% in the noncirrhotic and cirrhotic subgroups, respectively [28]

Summary

Introduction

Liver cirrhosis and hepatocellular carcinoma (HCC) are the major complications of chronic hepatitis B (CHB) [1]. Long-term nucleos(t)ide analogue (NA) therapy leads to the regression of liver fibrosis and cirrhosis and reduces the incidence of HCC [2,3,4,5]. The risk of HCC occurrence remains, in a recent large cohort of 1951 Caucasian patients with CHB under entecavir or tenofovir treatment, the 8-year survival rate was found to be similar to that for the general. The severity of liver fibrosis has been known to be a crucial risk factor for HCC development. Many noninvasive indices or modalities have been utilised instead of liver biopsy to predict liver fibrosis status [9,10,11].

Methods

Results

Conclusion