#thinkhepatitis #YellowWarriorsSociety PH #share so that others may be aware Some patients with hepatitis B should be screened for HCC Thu, 12/11/14 - 08:44 By Lorraine L. Janeczko NEW YORK (Reuters Health) - Screening some patients who have been cured of chronic hepatitis B (HBV) for hepatocellular carcinoma (HCC) is worthwhile, new research from Korea suggests. Doctors should consider screening cirrhotic patients and noncirrhotic males over age 50, even after hepatitis B surface antigen (HBsAg) seroclearance, if they have HBV genotype C, the authors reported online November 28 in the Journal of Hepatology. Though serum HBsAg loss is generally considered as a cure of HBV, the risk of future HCC development is still high. The incidence of HCC in cirrhotic patients is also high, wrote co-author Dr. Han Chu Lee of the University of Ulsan in Seoul, in email to Reuters Health. These data apply only to patients infected with HBV genotype C. The incidences of HCC in other genotypes are still unknown, he added. In a phone interview, Dr. Robin Kim of the University of Utah in Salt Lake City who was not involved in the study, said, This is a very intriguing initial finding that may ultimately result in changes in patient management. I think it is too preliminary, though, to use this paper alone to create guidelines that impact patient care. Dr. Lee and colleagues reviewed data on 829 patients who achieved HBsAg seroclearance. The mean age was 52.3 years; 575 patients were male; and 98 had cirrhosis. During a follow up of 3,464 patient-years, 19 patients developed HCC, for an annual rate of 0.55%. HCC was independently associated with liver cirrhosis (hazard ratio, 10.80), male gender (HR, 8.96), and age at least 50 (HR, 12.14) at the time of HBsAg seroclearance. The estimated annual incidence of HCC was 2.85% in patients with cirrhosis and 0.29% in patients without cirrhosis. Among the noncirrhotic patients, there were no cases of HCC in females. In males, the annual was 0.40%, and all cases developed after age 50. Dr. Alan W. Hemming of the University of California, San Diego, told Reuters Health by email, Patients who develop cirrhosis clearly need to be in HCC surveillance programs. This study would suggest that in addition, even those noncirrhotic male patients who seroconvert but are over age 50 should be considered for HCC screening. Early HCC detection through screening of at-risk populations allows earlier treatment and possible cure, added Dr. Hemming, who was not involved in the study. Dr. Lee realizes that having a population with just a single genotype is a limitation. It is well known that the risk of HCC is highest in HBV genotype C, but there are no data on the incidence of HCC in patients infected with other genotypes who have lost serum HBsAg, he wrote. Dr. Kim said by phone, The authors have found that indeed, despite the fact that you clear hepatitis B surface antigen, you are at risk for developing HCC. So they have determined that, in patients with cirrhosis or in noncirrhotic male patients over 50, surveying for hepatocellular cancer is advisable. This is important because it establishes a potential guideline, which has until this time been very unclear. Hepatitis B has multiple modes of inducing cancer in the liver, and cirrhosis is one of them. The virus may be cleared, but its end effects may have already resulted in liver changes that promote cancer. Whether or not they have a virus, cirrhotic patients are at risk for developing cancer, he said. To truly affect guideline changes that would impact how we deliver care, how we pay for delivery of care, and how we heighten our patient surveillance, I think a properly controlled prospective study is the best and most powerful statistical confirmation that these findings are valid, Dr. Kim added. He suggested that, if a prospective study may not be realistic due to the time and money required, this retrospective study needs to be validated with a larger cohort in various centers in North America or elsewhere. SOURCE: bit.ly/1BauAbq
Posted on: Mon, 15 Dec 2014 13:44:01 +0000