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Nested case–control study: hepatocellular carcinoma risk after hepatitis B surface antigen seroclearance
Author(s) -
Gounder P. P.,
Bulkow L. R.,
Snowball M.,
Negus S.,
Spradling P. R.,
Simons B. C.,
McMahon B. J.
Publication year - 2016
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13621
Subject(s) - medicine , hbsag , hepatocellular carcinoma , hazard ratio , hbeag , gastroenterology , hepatitis b virus , cohort , confidence interval , proportional hazards model , immunology , virus
Summary Background Hepatocellular carcinoma (HCC) risk after resolving chronic hepatitis B virus (HBV) infection is unclear. Aim To compare HCC risk between Alaska Native (AN) patients with and without hepatitis B surface antigen (HBsAg) seroclearance. Methods We selected persons with (case‐patients) and without (control‐patients) HBsAg seroclearance from a cohort of 1346 chronically HBV‐infected AN patients followed during 1982‒2013. We attempted to match two control‐patients/case‐patient on sex, HBV genotype, and age. Person‐years of follow‐up for case‐patients began on the date of HBsAg resolution and for control‐patients began on the date equivalent to the cohort entry date plus the years of HBsAg duration for their corresponding case‐patient. We compared HCC risk using a Cox proportional hazards model. Results The 238 case‐patients (4 with HCC) and 435 control‐patients (9 with HCC) were similar in age [ P ‐value ( P ) = 0.30], sex ( P = 0.53) and HBV genotype ( P = 0.99). Case‐patients had longer person‐years of follow‐up than control‐patients (11.7 vs. 10.1 years; P = 0.04). The HCC rate/100 000 persons was similar between case‐ (132) and control‐patients (178; P = 0.65). The adjusted hazard ratio comparing case‐ and control‐patients was similar for HCC [0.7; 95% confidence interval (CI): 0.2–2.4], increased for each 1‐year increment for age (1.1; CI: 1.0–1.1; P < 0.01), and was greater if the initial HBeAg was positive (3.5; CI: 1.1–11.0; P = 0.03). Conclusions Hepatitis B surface antigen seroclearance was not associated with reduced HCC risk; the HCC risk estimates are limited by wide 95% confidence intervals. Persons meeting HCC surveillance indications prior to HBsAg seroclearance could benefit from continued surveillance after seroclearance.