Predictive factors for hepatocellular carcinoma in chronic hepatitis B using structural equation modeling: a prospective cohort study - 28/10/21
for the ANRS/AFEF Hepather study group
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Highlights |
• | We explored the pathways leading to hepatocellular carcinoma in hepatitis B disease. |
• | The relationships between clinical characteristics and the cancer were analyzed. |
• | Liver fibrosis has a key role in the occurrence of hepatocellular carcinoma. |
• | The risk of occurrence is increased among elderly men with a metabolic syndrome. |
• | Excessive alcohol consumption is also associated with a higher risk. |
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.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : AFEF, AFP, ALP, ANR, ANRS, AST, BMI, CFI, CPP, DGS, DNA, EASL, ENT, FIB-4 index, GGT, HBeAg, HBV, HCC, HCV, HDL, HIV, HTN, INR, INSERM, MELD, NAFLD, NNFI, PAL, PNPLA3, RMSEA, SEM, SRMR, TDF, ULN
Keywords : Hepatocellular carcinoma, Hepatitis B virus, Hepatocarcinogenesis, Liver cancer, Epidemiology
Mappa
Vol 45 - N° 5
Articolo 101713- Settembre 2021 Ritorno al numero
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