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Reduced risk of hepatocellular carcinoma by achieving a subcirrhotic liver stiffness through antiviral agents in hepatitis B virus-related advanced fibrosis or cirrhosis

 Byung Seok Kim  ;  Yeon Seok Seo  ;  Young Seok Kim  ;  Chang Hyeong Lee  ;  Han Ah Lee  ;  Soon Ho Um  ;  Jeong-Ju Yoo  ;  Sang Gyune Kim  ;  Sang Jun Suh  ;  Young Kul Jung  ;  Sang Hoon Ahn  ;  Kwang-Hyub Han  ;  Hyung Joon Yim  ;  Seung Up Kim 
 Journal of Gastroenterology and Hepatology, Vol.33(2) : 503-510, 2018 
Journal Title
 Journal of Gastroenterology and Hepatology 
Issue Date
Aged ; Antiviral Agents/*therapeutic use ; Hepatocellular/*etiology/*prevention & control Carcinoma ; Female ; Chronic/*complications/*drug therapy Hepatitis B ; Humans ; Liver Cirrhosis/*etiology ; Liver Neoplasms/*etiology/*prevention & control ; Male ; Middle Aged ; Risk
antiviral therapy ; cirrhosis ; hepatitis B ; hepatocellular carcinoma ; liver fibrosis ; liver stiffness ; transient elastography
BACKGROUND AND AIM: A subcirrhotic range of liver stiffness (sc-LS), assessed by transient elastography, is associated with better outcomes in patients with chronic hepatitis B (CHB). We investigated whether the achievement of sc-LS by antiviral therapy (AVT) reduced the risk of developing hepatocellular carcinoma (HCC) in patients with CHB-related advanced fibrosis or cirrhosis. METHODS: In total, 209 patients with CHB-related advanced fibrosis or cirrhosis, who received paired transient elastography examinations during AVT between 2007 and 2012, were enrolled. The cut-off LS value for ultrasonographic cirrhosis was defined as 11.6 kPa. RESULTS: The median age of the study population was 51 years, with males predominating (n = 138, 66.0%). The median LS value at enrollment was 14.1 kPa (interquartile range: 9.5-24.1 kPa). After 2 years of AVT, 140 (67.0%) patients achieved sc-LS. During the study period, 28 (13.4%) patients developed HCC after 2 years of AVT. On multivariate analysis, the achievement of sc-LS after AVT was independently associated with a decreased risk of HCC development (hazard ratio [HR] = 0.485, P = 0.047), whereas older age (HR = 1.071) and male gender (HR = 3.704) were independently associated with an increased HCC risk (both P < 0.05). Patients with a cirrhotic range of LS value after 2 years of AVT were at a higher risk of HCC development than those with sc-LS (log-rank test, P = 0.020). CONCLUSIONS: The achievement of sc-LS after AVT can reduce the risk of HCC development in patients with CHB, even when advanced fibrosis or cirrhosis is apparent on starting AVT.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
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