Many patients with hepatocellular carcinoma and chronic hepatitis B also have underlying cirrhosis

Liz Meszaros, MDLinx

Digestive Disease Week® (DDW)

San Diego, California, United States | May 21-24, 2016


San Diego, CA, May 21, 2016—In a sample of US veterans with hepatocellular carcinoma (HCC) and chronic hepatitis B (CHB) infection, researchers found that only a small proportion (9.1%) did not have underlying cirrhosis, and that the only factors associated with the development of HCC in CHB patients without cirrhosis were being of African American and Asian race. In addition, they found that infection with hepatitis B virus (HBV) DNA did not differ between HCC patients with or without cirrhosis, according to data presented here at Digestive Disease Week 2016.

Take-home messages

  • A large proportion of patients with hepatocellular carcinoma with chronic hepatitis B infection have cirrhosis.
  • The only factors associated with the development of hepatocellular carcinoma in chronic hepatitis B patients without cirrhosis were being of African American and Asian race.

Maneerat Chayanupatkul, MD, a second-year fellow in gastroenterology, Baylor College of Medicine, Houston, TX, and colleagues conducted this cross-sectional study, enrolling HCC patients who had been identified in the Corporate Data Warehouse of the Department of Veterans Affairs (VA) between 2001 and 2014 and diagnosed with CHB.

They defined CHB as two positive test results for HBV, including HBsAg, HBeAg, or HBV DNA. Dr. Chayanupatkul and colleagues defined the absence of cirrhosis within 1 year before or at the time of HCC diagnosis via the presence of non-cirrhotic histopathology on liver biopsy, no cirrhotic configuration or signs of portal hypertension upon imaging, no evidence of esophageal or gastric varices or portal gastropathy upon upper endoscopy, and an FIB-4 score less than 1.81.

Dr. Chayanupatkul and colleagues compared the following variables between CHB patients with HCC with cirrhosis, and CHB patients with HCC without cirrhosis: age, gender, race, HBV DNA, HBeAg status, alcohol use, diabetes, elevated BMI, HC or HIV co-infection, ALT elevation, and anti-viral therapy before HCC diagnosis.

In all, 327 CHB patients had verified HCC, most were white males (51.8%) with a mean age of 55.5 years. Of these patients, a full 79.9% (n=263) had cirrhosis, 9.1% had no cirrhosis, and 10.3% were indeterminate for cirrhosis, which researchers defined as patients without available liver biopsies, but having an FIB-4 score of 1.81 to 3.25.

Dr. Chayanupatkul and fellow researchers found that, compared with patients with cirrhosis, HCC patients without cirrhosis were more likely to be African American and Asian. Furthermore, they found that the proportion of patients with high HBV DNA was similar between the cirrhotic and non-cirrhotic groups. They found no differences among the three groups in age, gender, BHeAg status, alcohol use, diabetes, BMI, HCV or HIV co-infection, ALT elevation, or the use of anti-viral therapy.

“If you have patients in your clinic who meet the highest criteria of having HCC, such as those who are African American, Asian, or who have a family history of HCC or cirrhosis—those patients are at high risk—and they should have screening for HCC every 6 months with alpha-fetoprotein or MRI. If you screen these patients, you give them a chance of receiving therapy,” concluded Dr. Chayanupatkul.