Clin Mol Hepatol.  2016 Sep;22(3):339-349. 10.3350/cmh.2016.0021.

Obesity and hepatocellular carcinoma in patients receiving entecavir for chronic hepatitis B

• Lee J
• Yoo SH
• Sohn W
• Kim HW
• Choi YS
• Won JH
• Heo JY
• Park SJ
• Park YM

• KMID: 2373134
• DOI: http://doi.org/10.3350/cmh.2016.0021

Abstract

BACKGROUND/AIMS
This study aimed to clarify the effect of obesity on the development of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients receiving antiviral treatment.
METHODS
This study applied a retrospective analysis to a historical cohort in Bundang Jesaeng Hospital. In total, 102 CHB patients were treated with entecavir as an initial treatment for CHB and checked for obesity using a body composition analyzer. Hepatic steatosis was measured semiquantitatively using Hamaguchi's scoring system in ultrasonography. Risk factors for the development of HCC were analyzed, including obesity-related factors (body mass index [BMI], waist circumference [WC], waist-to-hip ratio [WHR], visceral fat area [VFA], and hepatic steatosis).
RESULTS
The median follow-up duration of the patients was 45.2 months (interquartile range: 36.0-58.3 months). The cumulative incidence rates of HCC at 1 year, 3 years, and 5 years were 0%, 5.3%, and 9.0%, respectively. Univariable analysis revealed that the risk factors for HCC development were a platelet count of <120,000 /mm² (hazard ratio [HR]=5.21, P=0.031), HBeAg negativity (HR=5.61, P=0.039), and liver cirrhosis (HR=10.26, P=0.031). Multivariable analysis showed that the significant risk factor for HCC development was liver cirrhosis (HR=9.07, P=0.042). However, none of the obesity-related risk factors were significantly associated with HCC: BMI ≥25 kg/m² (HR=0.90, P=0.894), WC ≥90 cm (HR=1.10, P=0.912), WHR ≥0.9 (HR=1.94, P=0.386), VFA ≥100 cm² (HR=1.69, P=0.495), and hepatic steatosis (HR=0.57, P=0.602).
CONCLUSION
HCC development is associated with liver cirrhosis but not obesity-related factors in CHB patients receiving entecavir.

Keyword

Chronic hepatitis B; Hepatocellular carcinoma; Obesity; Antiviral treatment

MeSH Terms

Adult
Antiviral Agents/*therapeutic use
Body Mass Index
Carcinoma, Hepatocellular/epidemiology/*etiology
Cohort Studies
DNA, Viral/blood
Female
Guanine/*analogs & derivatives/therapeutic use
Hepatitis B virus/genetics/isolation & purification
Hepatitis B, Chronic/complications/*drug therapy/virology
Humans
Incidence
Liver Cirrhosis/complications
Liver Neoplasms/epidemiology/*etiology
Male
Middle Aged
Obesity/*complications
Proportional Hazards Models
Retrospective Studies
Risk Factors
Viral Load
Antiviral Agents
DNA, Viral
Guanine