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

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Abstract

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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Funding

The authors declare that they have no financial support in association with this paper.

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Author notes

  1. Joo Hyun Oh, Hye Won Lee and Dong Hyun Sinn contributed equally to this paper as co-first authors.

Authors and Affiliations

  1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    Joo Hyun Oh, Dong Hyun Sinn, Wonseok Kang, Geum-Youn Gwak, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik & Yong-Han Paik

  2. Department of Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 280-1, Hangeulbiseok-ro, Nowon-gu, Seoul, 01830, Republic of Korea

    Joo Hyun Oh

  3. Department of Internal Medicine, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Hye Won Lee, Jun Yong Park, Beom Kyung Kim, Seung Up Kim, Do Young Kim & Sang Hoon Ahn

  4. Yonsei Liver Center, Severance Hospital, Seoul, 03722, Republic of Korea

    Hye Won Lee, Jun Yong Park, Beom Kyung Kim, Seung Up Kim, Do Young Kim & Sang Hoon Ahn

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Contributions

JHO, HWL, and DHS performed the statistical analyses and interpretation of data and prepared the draft of the manuscript. JHO and HWL collected the data. WK, DHS, GYG, MSC, JHL, KCK, and SWP supervised the statistical analyses and interpretation of data. BKK, SUK, DYK, and SHA performed a critical revision of the manuscript. YHP, DHS and JYP conceived the study, designed the study, and performed the statistical analyses and interpretation of data. All authors reviewed the manuscript for critical content and approved the final version.

Corresponding authors

Correspondence to Dong Hyun Sinn or Jun Yong Park.

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Conflict of interest

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 declare no conflict of interest.

Ethical approval

The study was performed in accordance with the principle of the Declaration of Helsinki. The Institutional Review Board at Samsung Medical Center and Severance Hospital reviewed and approved the protocol. As the study used only de-identified data routinely collected during hospital visits, the requirement to obtain informed patient consent was waived.

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Oh, J.H., Lee, H.W., Sinn, D.H. et al. Controlled attenuation parameter value and the risk of hepatocellular carcinoma in chronic hepatitis B patients under antiviral therapy. Hepatol Int 15, 892–900 (2021). https://doi.org/10.1007/s12072-021-10205-7

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