Eui Joo Kim1, Jong Eun Yeon2, Oh Sang Kwon3, Heon Nam Lee1, Seung Kak Shin1, Seong Hee Kang2, Kwan Soo Byun2, Jeong Han Kim4, So Young Kwon4, Sang Jun Suh5, Hyung Joon Yim5, Yun Soo Kim1, Ju Hyun Kim1. 1. Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea. 2. Department of Internal Medicine, Korea University Medical College, Korea University Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 08308, South Korea. 3. Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea. kos@gilhospital.com. 4. Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, South Korea. 5. Department of Internal Medicine, Korea University Medical College, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, South Korea.
Abstract
BACKGROUND: Sustained abnormal serum alanine aminotransferase (ALT) levels can increase the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. AIM: This study is aimed to confirm the impact of rapid ALT normalization (≤30 IU/L) on HCC risk in patients with hepatitis B virus (HBV)-associated cirrhosis after entecavir (ETV) commencement. METHODS: A total of 578 treatment-naïve patients with HBV-associated cirrhosis (mean age 51 ± 9 years, male sex 63.3%) were treated with ETV for more than 1 year. Serum ALT and HBV DNA levels were measured at three time points (baseline, 6, and 12 months after ETV commencement) and subjected to risk factor analysis. RESULTS: Median follow-up after ETV commencement was 43 (12-98) months. Cumulative incidences of HCC at 1, 3, 5, and 7 years were 0.3, 8.5, 19.5, and 30.6%, respectively. Univariate Cox regression analysis showed that older age, abnormal ALT at 6 months or 12 months, and lower platelet count were significant risk factors for HCC. However, gender, HBeAg positivity, abnormal ALT levels or HBV DNA levels at baseline, and detectable HBV DNA at 6 or 12 months were not risk factors. Multivariate analysis showed that older age (P < 0.001), abnormal ALT at 12 months (P = 0.006), and lower platelet count (P = 0.034) were the risk factors for HCC. CONCLUSIONS: Abnormal serum ALT levels after ETV commencement are significant risk factor for HCC. Therefore, ALT should be rapidly normalized to minimize the risk of HCC development in patients with HBV-associated cirrhosis.
BACKGROUND: Sustained abnormal serum alanine aminotransferase (ALT) levels can increase the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. AIM: This study is aimed to confirm the impact of rapid ALT normalization (≤30 IU/L) on HCC risk in patients with hepatitis B virus (HBV)-associated cirrhosis after entecavir (ETV) commencement. METHODS: A total of 578 treatment-naïve patients with HBV-associated cirrhosis (mean age 51 ± 9 years, male sex 63.3%) were treated with ETV for more than 1 year. Serum ALT and HBV DNA levels were measured at three time points (baseline, 6, and 12 months after ETV commencement) and subjected to risk factor analysis. RESULTS: Median follow-up after ETV commencement was 43 (12-98) months. Cumulative incidences of HCC at 1, 3, 5, and 7 years were 0.3, 8.5, 19.5, and 30.6%, respectively. Univariate Cox regression analysis showed that older age, abnormal ALT at 6 months or 12 months, and lower platelet count were significant risk factors for HCC. However, gender, HBeAg positivity, abnormal ALT levels or HBV DNA levels at baseline, and detectable HBV DNA at 6 or 12 months were not risk factors. Multivariate analysis showed that older age (P < 0.001), abnormal ALT at 12 months (P = 0.006), and lower platelet count (P = 0.034) were the risk factors for HCC. CONCLUSIONS: Abnormal serum ALT levels after ETV commencement are significant risk factor for HCC. Therefore, ALT should be rapidly normalized to minimize the risk of HCC development in patients with HBV-associated cirrhosis.
Entities:
Keywords:
Alanine aminotransferase; Cirrhosis; Entecavir; Hepatitis B virus; Hepatocellular carcinoma
Authors: Emmet B Keeffe; Douglas T Dieterich; Steven-Huy B Han; Ira M Jacobson; Paul Martin; Eugene R Schiff; Hillel Tobias Journal: Clin Gastroenterol Hepatol Date: 2008-08-23 Impact factor: 11.382
Authors: Seung Kak Shin; Hyung Joon Yim; Jeong Han Kim; Chan Uk Lee; Jong Eun Yeon; Sang Jun Suh; Young Kul Jung; Yun Soo Kim; Ju Hyun Kim; Oh Sang Kwon Journal: Gut Liver Date: 2021-05-15 Impact factor: 4.519