Predictive factors for hepatocellular carcinoma in chronic hepatitis B using structural equation modeling: a prospective cohort study.

Abstract

BACKGROUND & AIMS:

The factors predicting hepatocellular carcinoma (HCC) occurrence in chronic hepatitis B need to be precisely known to improve its detection. We identified pathways and individual predictive factors associated with HCC in the ANRS CO22 HEPATHER cohort.

METHODS:

The study analyzed HBV-infected patients recruited at 32 French expert hepatology centers from August 6, 2012, to December 31, 2015. We excluded patients with chronic HCV, HDV and a history of HCC, decompensated cirrhosis or liver transplantation. Structural equation models were developed to characterize the causal pathways leading to HCC occurrence. The association between clinical characteristics (age, gender, body-mass index, liver fibrosis, alcohol consumption, smoking status, diabetes, hypertension, dyslipidemia, alpha-fetoprotein, HBV DNA levels, antiviral therapy) and incident HCC was quantified.

RESULTS:

Among the 4489 patients included, 33 patients reported incident HCC. The median follow-up was 45.5 months. Age (β = 0.18 by decade, 95% CI 0.14-0.23), male gender (β = 0.23, 95% CI 0.18-0.29), metabolic syndrome (β = 0.28, 95% CI 0.22-0.33), alcohol consumption (β = 0.09, 95% CI 0.05-0.14) and HBV DNA (β = 0.25, 95% CI 0.170.34) had a significant and direct effect on the occurrence of advanced liver fibrosis. Liver fibrosis (β = 0.71, 95% CI 0.55-0.87) predicted, in turn, the occurrence of HCC.

CONCLUSIONS:

Liver fibrosis mediates the effects of age, gender, alcohol, metabolic syndrome and HBV DNA on the occurrence of HCC. Elderly men with chronic hepatitis B, risky alcohol use, advanced liver fibrosis, metabolic syndrome and high HBV DNA levels should be monitored closely to detect the development of HCC.

• Authors: Laurent Lam, Hélène Fontaine, Marc Bourliere, Clovis Lusivika-Nzinga, Céline Dorival, Dominique Thabut, Fabien Zoulim, François Habersetzer, Tarik Asselah, Jean-Charles Duclos-Vallee, Jean-Pierre Bronowicki, Philippe Mathurin, Thomas Decaens, Nathalie Ganne, Dominique Guyader, Vincent Leroy, Isabelle Rosa, Victor De Ledinghen, Paul Cales, Xavier Causse, Dominique Larrey, Olivier Chazouilleres, Moana Gelu-Simeon, Véronique Loustaud-Ratti, Sophie Metivier, Laurent Alric, Ghassan Riachi, Jérôme Gournay, Anne Minello, Albert Tran, Claire Geist, Armand Abergel, François Raffi, Louis D'Alteroche, Isabelle Portal, Nathanaël Lapidus, Stanislas Pol, Fabrice Carrat, ANRS/AFEF Hepather study group
• Journal: Clinics and research in hepatology and gastroenterology (Clin Res Hepatol Gastroenterol) Vol. 45 Issue 5 Pg. 101713 (09 2021) ISSN: 2210-741X [Electronic] France
• PMID: 33930591 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Elsevier Masson SAS. All rights reserved.

Topics

• Aged
• Carcinoma, Hepatocellular (epidemiology)
• Hepatitis B, Chronic (epidemiology)
• Humans
• Liver Neoplasms (epidemiology)
• Male
• Prospective Studies
• Risk Factors