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Relationship between HB sAg, HB crAg and hepatocellular carcinoma in patients with undetectable HBV DNA under nucleos(t)ide therapy
Author(s) -
Cheung K.S.,
Seto W.K.,
Wong D. K.H.,
Lai C.L.,
Yuen M.F.
Publication year - 2017
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12688
Subject(s) - hepatocellular carcinoma , gastroenterology , medicine , receiver operating characteristic , carcinoma
Summary We examined the relationship between hepatitis B surface and core‐related antigens ( HB sAg, HB crAg) and hepatocellular carcinoma ( HCC ) development in patients with undetectable serum HBV DNA receiving nucleos(t)ide analogue ( NA ). Seventy‐six HBV carriers with undetectable HBV DNA (<20 IU / mL ) who subsequently developed HCC were compared with 152 matched controls. Clinical and laboratory parameters (including novel assays to measure linearized HB sAg [ HQ ‐ HB sAg] and HB crAg) were analysed. There were no significant differences in HB sAg/ HQ ‐ HB sAg levels between the two groups. There was a significant difference in the median values of both pre‐ and post‐ NA HB crAg levels between the HCC and control groups (pre‐treatment: 279.0 vs 35.4 kU / mL , P =.005; post‐treatment: 10.2 vs 1.7 kU / mL , P =.005, respectively). For the whole HCC group, a cut‐off value of post‐treatment HB crAg level ≥7.8 kU / mL yielded an area under receiver operating curve ( AUROC ) of 0.61 with a negative predictive value ( NPV ) of 77.0%. The OR of HCC development was 3.27. For noncirrhotic patients, the median values of post‐treatment HB crAg level of HCC group and controls were 10.2 and 1.0 kU / mL , respectively ( P =.001). A cut‐off value of HB crAg level ≥7.9 kU / mL yielded an AUROC of 0.70 with a NPV of 80.6%. The OR of HCC development was 5.95. A higher pre‐ and post‐ NA treatment HB crAg level (but not HB sAg) was associated with an increased risk of HCC development in patients achieving undetectable serum HBV DNA while on NA therapy. HB crAg may serve as a novel risk marker for HCC in this group of patients.