J Korean Med Sci.  2015 Nov;30(11):1618-1624. 10.3346/jkms.2015.30.11.1618.

Hepatocellular Carcinoma Risk of Compensated Cirrhosis Patients with Elevated HBV DNA Levels according to Serum Aminotransferase Levels

• Lee J
• Sinn DH
• Kim JH
• Gwak GY
• Kim HS
• Jung SH
• Paik YH
• Choi MS
• Lee JH
• Koh KC
• Yoo BC
• Paik SW

• KMID: 2351112
• DOI: http://doi.org/10.3346/jkms.2015.30.11.1618

Abstract

Sometimes, hepatitis B virus (HBV)-related cirrhotic patients with normal aminotransferase levels are closely followed-up for the elevation of aminotransferase levels instead of prompt antiviral therapy (AVT). We analyzed the long-term hepatocellular carcinoma (HCC) risk according to the aminotransferase levels in a retrospective cohort of 1,468 treatment-naive, HBV-related, compensated cirrhosis patients with elevated HBV DNA levels (> or =2,000 IU/mL). Based on aminotransferase levels, patients were categorized into normal (< 40 U/L, n = 364) and elevated group (> or =40 U/L, n = 1,104). During a median of 5.3 yr of follow-up (range: 1.0-8.2 yr), HCC developed in 296 (20%) patients. The 5-yr cumulative HCC incidence rate was higher in patients with elevated aminotransferase level, but was not low in normal aminotransferase level (17% vs. 14%, P = 0.004). During the follow-up, 270/364 (74%) patients with normal aminotransferase levels experienced elevation of aminotransferase levels, and AVT was initiated in 1,258 (86%) patients. Less patients with normal aminotransferase levels received AVT (70% vs. 91%, P < 0.001) and median time to start AVT was longer (17.9 vs. 2.4 months, P < 0.001). AVT duration was an independent factor associated with HCC, and median duration of AVT was shorter (4.0 vs. 2.6 yr, P < 0.001) in patients with normal aminotransferase levels. The HCC risk of compensated cirrhosis patients with normal aminotransferase level is not low, and AVT duration is associated with lowered HCC risk, indicating that prompt AVT should be strongly considered even for those with normal aminotransferase levels.

Keyword

Liver Neoplasms; Antiviral Therapy; Aminotransferase; Treatment; Viruses

MeSH Terms

Alanine Transaminase/*blood
Biomarkers/blood
Carcinoma, Hepatocellular/*blood/*epidemiology
Causality
Comorbidity
DNA, Viral/blood
Female
Hepatitis B/blood/*epidemiology
Hepatitis B virus/genetics
Humans
Incidence
Liver Cirrhosis/blood/drug therapy/epidemiology
Liver Neoplasms/*blood/*epidemiology
Male
Middle Aged
Reproducibility of Results
Republic of Korea/epidemiology
Risk Factors
Sensitivity and Specificity
Alanine Transaminase
Biomarkers
DNA, Viral

Figure

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  Fig. 1 Cumulative incidence rate of hepatocellular carcinoma according to the serum aminotransferase levels. When the aminotransferase groups were compared, the cumulative HCC incidence rate was significantly higher in patients with elevated aminotransferase levels than normal aminotransferase levels (P = 0.004).

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  Fig. 2 Cumulative incidence rate of hepatocellular carcinoma according to the serum aminotransferase levels and use of antiviral therapy during follow-up. The 5-yr cumulative HCC incidence rate was highest in patients with elevated aminotransferase levels who did not received antiviral therapy (38%, yellow, group 1), followed by patients with normal aminotransferase levels who did not received antiviral therapy (21%, blue, group 2), patients with elevated aminotransferase levels who received antiviral therapy (15%, purple, group 3), and patients with normal aminotransferase levels who received antiviral therapy (12%, green, group 4).

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