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27-04-2016 | HBV | News | Article

HBcrAg may predict HCC development

medwireNews: Research suggests a role for hepatitis B core-related antigen (HBcrAg) in the prediction of hepatocellular carcinoma (HCC) development in nucleos(t)ide analogue treatment-naïve patients with chronic hepatitis B virus (HBV) infection.

Researcher Toshifumi Tada (Ogaki Municipal Hospital, Japan) and team say that HBcrAg is “superior to HBV DNA [– a previously reported HCC risk predictor –] in terms of predictive power for HCC development.”

But they stress the need for further prospective studies in community-based cohorts and patients who have received nucleos(t)ide analogue therapy.

During a median follow-up of 10.7 years, 78 of 1031 chronic HBV patients included in this medical review were diagnosed with HCC. The cumulative incidence rate of HCC was 2.0% at 5 years, rising to 8.3%, 10.7% and 12.5% at 10, 15 and 20 years, respectively.

Multivariate analysis taking into account various virus-related markers, such as HBV genotype and HBV DNA levels, showed that HBcrAg levels over 2.9 log U/mL predicted HCC development with a significant hazard ratio (HR) of 5.05 (p<0.001). The only other factor significantly associated with HCC progression was the presence of basal core promoter mutations (HR=28.85; p<0.001).

The cumulative incidence of HCC among patients with HBcrAg levels above 2.9 log U/mL and a basal core promoter mutation ranged from 6.4% at 5 years to 34.4% at 20 years, significantly higher than among their wild-type counterparts with HBcrAg levels at or below the cutoff, in whom it was 0.0% at all timepoints (p<0.001).

The accuracy of HBcrAg to predict HCC incidence, as estimated by time-dependant receiver operating characteristic analysis, was higher than for HBV DNA at all timepoints, at, for instance, 80% versus 75% at 2 years and 70% versus 65% at 10 years.

The authors conclude in the Journal of Hepatology that the “[e]levation of HBcrAg levels in [chronic HBV] patients is associated with the development of HCC”, adding that in their view “HBcrAg is an excellent predictor” of progression to HCC.

By Shreeya Nanda

medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016