Hepatocellular carcinoma risk in HB eAg‐negative chronic hepatitis B patients with or without cirrhosis treated with entecavir: HepNet.Greece cohort

• Published in: Journal of viral hepatitis Vol. 22; no. 2; pp. 120 - 127
• Main Authors: Papatheodoridis, G. V., Manolakopoulos, S., Touloumi, G., Nikolopoulou, G., Raptopoulou‐Gigi, M., Gogos, C., Vafiadis‐Zouboulis, I., Karamanolis, D., Chouta, A., Ilias, A., Drakoulis, C., Mimidis, K., Ketikoglou, I., Manesis, E., Mela, M., Hatzis, G., Dalekos, G. N.
• Format: Journal Article
• Language: English
• Published: 01.02.2015
• ISSN: 1352-0504; 1365-2893
• DOI: 10.1111/jvh.12283

Summary Hepatocellular carcinoma ( HCC ) may still develop in chronic hepatitis B ( CHB ) patients treated with lamivudine. Whether HCC rates are comparable in patients treated with the current first‐line antivirals remains uncertain. We estimated the incidence and evaluated predictors of HCC in a large nationwide prospective cohort (HepNet.Greece) of HB eAg‐negative CHB patients treated with entecavir. HB eAg‐negative CHB patients from the same cohort who were initially treated with lamivudine were used as controls. We included 321 patients treated with entecavir for a median of 40 months and 818 patients treated initially with lamivudine for a median of 60 months. In the entecavir group, HCC developed in 4 of 321 (1.2%) patients at a median of 1.5 (range: 1.0–4.5) years, while the cumulative HCC incidence was significantly higher in cirrhotics than noncirrhotics (1, 3, 5 years: 0%, 3%, 9% vs 1%, 1%, 1%; P  = 0.024) and in older patients ( P  = 0.026). Entecavir compared with lamivudine group patients had lower HCC incidence (1, 3, 5 years: 0.3%, 1.2%, 2.8% vs 0.7%, 3.8%, 5.6%; P  = 0.024). However, in multivariable Cox regression analysis, the HCC risk was independently associated with older age ( P  < 0.001), male gender ( P  = 0.011) and cirrhosis ( P  = 0.025), but not with the initial agent. In conclusion , our large nationwide study indicates that the HCC risk remains increased in entecavir‐treated HB eAg‐negative CHB patients with cirrhosis, particularly of older age, at least for the first 5 years. The HCC risk does not seem to be significantly reduced with entecavir compared with antiviral therapy starting with lamivudine.