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Controlled attenuation parameter value and the risk of hepatocellular carcinoma in chronic hepatitis B patients under antiviral therapy

 Joo Hyun Oh  ;  Hye Won Lee  ;  Dong Hyun Sinn  ;  Jun Yong Park  ;  Beom Kyung Kim  ;  Seung Up Kim  ;  Do Young Kim  ;  Sang Hoon Ahn  ;  Wonseok Kang  ;  Geum-Youn Gwak  ;  Moon Seok Choi  ;  Joon Hyeok Lee  ;  Kwang Cheol Koh  ;  Seung Woon Paik  ;  Yong-Han Paik 
 HEPATOLOGY INTERNATIONAL, Vol.15(4) : 892-900, 2021-08 
Journal Title
Issue Date
Antiviral Agents / therapeutic use ; Carcinoma, Hepatocellular* / drug therapy ; Carcinoma, Hepatocellular* / epidemiology ; Carcinoma, Hepatocellular* / etiology ; Elasticity Imaging Techniques ; Hepatitis B virus ; Hepatitis B, Chronic* / complications ; Hepatitis B, Chronic* / drug therapy ; Humans ; Liver Cirrhosis / drug therapy ; Liver Neoplasms* / drug therapy ; Liver Neoplasms* / epidemiology ; Liver Neoplasms* / etiology ; Risk Factors
Chronic hepatitis B ; Controlled attenuation parameter ; Hepatocellular carcinoma ; Transient elastography
Background: Controlled attenuation parameter (CAP) can evaluate hepatic steatosis in patients with chronic hepatitis B (CHB). However, prognostic implications of CAP value remain unclear. We evaluated the association between CAP and the risk of hepatocellular carcinoma (HCC) in patients with CHB under antiviral therapy and maintained virologic response.

Methods: A total of 1823 CHB patients who were taking nucleos(t)ide analogue and showing suppressed hepatitis B virus replication were analyzed. The primary outcome was incident HCC during follow-up. Patients were grouped into those with and without advanced chronic liver disease (ACLD) (liver stiffness measurement cutoff: 10 kPa), and those with and without hepatic steatosis (CAP cutoff: 222 dB/m).

Results: During 6.4 years of follow-up, 127 patients (7.0%) newly developed HCC. Among patients with ACLD (n = 382), the cumulative HCC incidence rate was lower for those with CAP ≥ 222 (11.0% at 5 years) than those with CAP < 222 (24.0% at 5 years, p = 0.002), and was an independent factor associated with HCC. When CAP value was further stratified, the cumulative HCC incidence rate decreased in dose-dependent manner according to an increase in CAP value (24.0%, 13.9%, 12.8% and 6.0% at 5 years for those with CAP < 222, 222-246, 247-273 and ≥ 274, respectively). Among patients without ACLD (n = 1441), there was no significance difference in HCC risk according to CAP value (HCC incidence rate: 3.3% and 4.0% at 5 years for those with CAP < 222 and CAP ≥ 222, p = 0.20).

Conclusions: Among CHB patients under antiviral therapy showing suppressed HBV replication, low CAP value predicted higher risk for HCC among ACLD patients, indicating that CAP value has a prognostic implication in this population.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Hye Won(이혜원) ORCID logo https://orcid.org/0000-0002-3552-3560
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