Sex modifies age-related HCC risk after HBsAg clearance
medwireNews: Achieving hepatitis B surface antigen (HBsAg) seroclearance neutralizes the increased risk for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) among women aged 50 years or younger, but not among older women or men regardless of their age, research indicates.
Age over 50 years is a known risk factor for HCC development after HBsAg clearance, explain the investigators from the Chinese University of Hong Kong, who sought to examine the interaction between age and sex.
Using the Clinical Data Analysis and Reporting System of the Hospital Authority, Hong Kong, they identified 4568 chronic HBV patients (62.9% male) who achieved HBsAg clearance between January 2000 and August 2016. Of these, 54 patients developed HCC over a median follow-up of 3.4 years.
In a multivariable analysis, age over 50 years and male sex were significantly associated with the risk for HCC development, with corresponding adjusted hazard ratios of 4.31 and 2.47 (p=0.002 and 0.01, respectively).
But Grace Lai-Hung Wong and co-authors found that sex modified the age-related risk for HCC. Specifically, the 5-year cumulative incidence of HCC was 0% among female patients of 50 years or younger, but 1.0% for women older than 50 years.
The 5-year HCC rate for men in the 50 years or younger age group was 0.7%, rising to 2.5% among those aged over 50 years.
The results were similar for the 3775 patients who spontaneously cleared HBsAg. But in the subgroup of 793 patients who achieved seroclearance in response to nucleos(t)ide analog therapy, HCC occurred only among men who were older than 50 years at the time of seroclearance.
“HBsAg seroclearance is regarded as a surrogate of ultimate immune control of HBV and a realistic antiviral treatment endpoint,” the researchers explain. However, their study suggests that the HCC risk persists even in patients who clear HBsAg, they add.
On the basis of their findings, Wong and team conclude in the Journal of Hepatology that “HCC surveillance may not be necessary for female patients with HBsAg seroclearance at 50 years or younger, but may still be cost-effective for other patients.”
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