Hepatocellular carcinoma risk in HBeAg‐negative chronic hepatitis B patients with or without cirrhosis treated with entecavir: HepNet.Greece cohort |
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| Authors: | G. V. Papatheodoridis S. Manolakopoulos G. Touloumi G. Nikolopoulou M. Raptopoulou‐Gigi C. Gogos I. Vafiadis‐Zouboulis D. Karamanolis A. Chouta A. Ilias C. Drakoulis K. Mimidis I. Ketikoglou E. Manesis M. Mela G. Hatzis G. N. Dalekos the HepNet.Greece Study Group |
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| Affiliation: | 1. Gastroenterology Department, Athens University Medical School, Laikon General Hospital of Athens, Athens, Attica, Greece;2. 2nd Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital of Athens, Athens, Attica, Greece;3. Department of Hygiene, Epidemiology & Medical Statistics, Athens University Medical School, Athens, Attica, Greece;4. Viral Hepatitis Committee, KEELPNO, Athens, Attica, Greece;5. 2nd Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece;6. Department of Internal Medicine, University of Patras, Rio, Achaia, Greece;7. 2nd Gastroenterology Department, Evangelismos General Hospital of Athens, Athens, Attiki, Greece;8. 4th Department of Internal Medicine, Athens University Medical School, Athens, Attica, Greece;9. Gastroenterology Department, Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece;10. 2nd Department of Internal Medicine, General Hospital of Piraeus, Athens, Greece;11. 1st Department of Internal Medicine, Democritus University of Thrace, Avdira, Greece;12. Department of Internal Medicine, Hippokration General Hospital of Athens, Athens, Greece;13. Division of Internal Medicine, Athens University Medical School, Athens, Attica, Greece;14. Gastroenterology Department, Polykliniki Hospital of Athens, Athens, Greece;15. Department of Pathophysiology, Athens University Medical School, Athens, Attica, Greece;16. Department of Medicine & Research Laboratory of Internal Medicine, Thessaly University Medical School, Larissa, Greece |
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| Abstract: | Hepatocellular carcinoma (HCC) may still develop in chronic hepatitis B (CHB) patients treated with lamivudine. Whether HCC rates are comparable in patients treated with the current first‐line antivirals remains uncertain. We estimated the incidence and evaluated predictors of HCC in a large nationwide prospective cohort (HepNet.Greece) of HBeAg‐negative CHB patients treated with entecavir. HBeAg‐negative CHB patients from the same cohort who were initially treated with lamivudine were used as controls. We included 321 patients treated with entecavir for a median of 40 months and 818 patients treated initially with lamivudine for a median of 60 months. In the entecavir group, HCC developed in 4 of 321 (1.2%) patients at a median of 1.5 (range: 1.0–4.5) years, while the cumulative HCC incidence was significantly higher in cirrhotics than noncirrhotics (1, 3, 5 years: 0%, 3%, 9% vs 1%, 1%, 1%; P = 0.024) and in older patients (P = 0.026). Entecavir compared with lamivudine group patients had lower HCC incidence (1, 3, 5 years: 0.3%, 1.2%, 2.8% vs 0.7%, 3.8%, 5.6%; P = 0.024). However, in multivariable Cox regression analysis, the HCC risk was independently associated with older age (P < 0.001), male gender (P = 0.011) and cirrhosis (P = 0.025), but not with the initial agent. In conclusion , our large nationwide study indicates that the HCC risk remains increased in entecavir‐treated HBeAg‐negative CHB patients with cirrhosis, particularly of older age, at least for the first 5 years. The HCC risk does not seem to be significantly reduced with entecavir compared with antiviral therapy starting with lamivudine. |
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| Keywords: | cirrhosis entecavir hepatitis B hepatocellular carcinoma lamivudine |
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