Impact of HBeAg on Hepatocellular Carcinoma Risk During Oral Antiviral Treatment in Patients With Chronic Hepatitis B

Heejoon Jang, Jun Sik Yoon, Soo Young Park, Han Ah Lee, Myoung jin Jang, Seung Up Kim, Dong Hyun Sinn, Yeon Seok Seo, Hwi Young Kim, Sung Eun Kim, Dae Won Jun, Eileen L. Yoon, Joo Hyun Sohn, Sang Bong Ahn, Jae Jun Shim, Soung Won Jeong, Yong Kyun Cho, Hyoung Su Kim, Joon Yeul Nam, Yun Bin LeeYoon Jun Kim, Jung Hwan Yoon, Fabien Zoulim, Pietro Lampertico, George N. Dalekos, Ramazan Idilman, Vana Sypsa, Thomas Berg, Maria Buti, Jose Luis Calleja, John Goulis, Spilios Manolakopoulos, Harry LA Janssen, George V. Papatheodoridis, Jeong Hoon Lee

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background & Aims: Antiviral treatment from hepatitis B envelope antigen (HBeAg)-positive status may attenuate the integration of hepatitis B virus DNA into the host genome causing hepatocellular carcinoma (HCC). We investigated the impact of HBeAg status at the onset of antiviral treatment on the risk of HCC. Methods: The incidence of HCC was evaluated in Korean patients with chronic hepatitis B who started entecavir or tenofovir in either HBeAg-positive or HBeAg-negative phase. The results in the Korean cohort were validated in a Caucasian PAGE-B cohort. Results: A total of 9143 Korean patients (mean age, 49.2 years) were included: 49.1% were HBeAg-positive and 49.2% had cirrhosis. During follow-up (median, 5.1 years), 916 patients (10.0%) developed HCC. Baseline HBeAg positivity was not associated with the risk of HCC in the entire cohort or cirrhotic subcohort. However, in the non-cirrhotic subcohort, HBeAg positivity was independently associated with a lower risk of HCC in multivariable (adjusted hazard ratio [aHR], 0.41; 95% confidence interval [CI], 0.26–0.66), propensity score-matching (aHR, 0.46; 95% CI, 0.28–0.76), and inverse probability weighting analyses (aHR, 0.44; 95% CI, 0.28–0.70). In the Caucasian cohort (n = 719; mean age, 51.8 years; HBeAg-positive, 20.3%; cirrhosis, 34.8%), HBeAg-positivity was not associated with the risk of HCC either in the entire cohort or cirrhotic subcohort. In the non-cirrhotic subcohort, none of the HBeAg-positive group developed HCC, although the difference failed to reach statistical significance (aHR, 0.21; 95% CI, 0.00–1.67). Conclusions: This multinational cohort study implies that HBeAg positivity at the onset of antiviral treatment seems to be an independent factor associated with a lower risk of HCC in patients with chronic hepatitis B without cirrhosis, but not in those with cirrhosis.

Original languageEnglish
Pages (from-to)1343-1353.e16
JournalClinical Gastroenterology and Hepatology
Volume20
Issue number6
DOIs
StatePublished - Jun 2022

Keywords

  • Cumulative Incidence
  • DNA
  • Hepatitis B Virus
  • Liver Cancer
  • Neoplasm

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