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( Yewan Park ),( Jeong-hoon Lee ),( Dong Hyun Sinn ),( Jun Yong Park ),( Minseok Albert Kim ),( Yoon Jun Kim ),( Jung-hwan Yoon ),( Do Young Kim ),( Sang Hoon Ahn ),( Wonseok Kang ),( Geum-youn Gwak ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Hepatocellular carcinoma (HCC) can develop after hepatitis B surface antigen (HBsAg) seroclearance. However, whether HCC risk differs between antiviral therapy (AVT)-induced or spontaneous seroclearance cases, and ways to identify atrisk populations remain unclear. We compared the HCC risk between AVT-induced and spontaneous cases and tested whether several HCC risk prediction models could be applied to HBsAg seroclearance patients. Methods: A retrospective cohort of 1,200 patients (median age: 56 years; 824 males; 165 with cirrhosis; 216 AVT-induced cases) who achieved HBsAg seroclearance were analyzed for the development of HCC after HBsAg seroclearance. The performance of five HCC prediction models, CU-HCC, GAG-HCC, REACH-B, PAGE-B, and modified PAGE-B, was assessed. Results: During a median of 4.8 years of follow-up (range: 0.5 - 17.8 years), HCC developed in 23 patients (1.9%). The HCC incidence rate was higher in the AVT-induced cases than in the spontaneous cases (3.9% vs. 0.9% at five years). AVT and cirrhosis were independent factors associated with HCC, with HCC incidence rates of 0.5%, 1.2%, 4.0%, and 10.5% at five years for spontaneous/no-cirrhosis, AVT-induced/no-cirrhosis, spontaneous/cirrhosis, and AVT-induced/cirrhosis patients, respectively. The area under the receiver operating curve (AUROC) for HCC development at five years was highest for CU-HCC scores (0.82). The HCC incidence was high for high CU-HCC scores (14.3% at five years) and high GAG-HCC scores (7.9% at five years), and was very low for low PAGE-B scores (0% at five years) or low modified PAGE-B scores (0% at five years). Conclusions: AVT-induced HBsAg seroclearance was associated with higher HCC risk, especially for patients with cirrhosis, indicating that they need careful monitoring for HCC risk. The HCC risk models were able to stratify the HCC risk in patients with HBsAg seroclearance.
( Jihye Kim ),( Dong Hyun Sinn ),( Yewan Park ),( Myung Ji Goh ),( Joo Hyun Oh ),( Wonseok Kang ),( Geum-youn Gwak ),( Yong-han Paik ),( Moon Seok Choi ),( Joon Hyeok Lee ),( Kwang Cheol Koh ),( Seung 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are potent nucleoside analogues (NAs) recommended as firstline monotherapies for chronic hepatitis B. There have been some hot debates on the clinical outcomes of the two agents regarding hepatocellular carcinoma (HCC) occurrence or recurrence among chronic hepatitis B patients. The objective of this study was to compare the survival of hepatitis B virus (HBV)-related HCC patients who started ETV or TDF at the time of HCC diagnosis. Methods: A total of 1,031 consecutive antiviral treatment-naive patients who started ETV (n=516) or TDF (n=515) monotherapy during two months before and after the initial HCC diagnosis between September 2012 and December 2017 were analyzed. Patients who had hepatitis C co-infection or received liver transplantation as the initial cancer-specific treatment were excluded. Overall survival of patients were compared between ETV and TDF groups. Results: The median age of the study patients was 55 years, and 80.3% were male. Barcelona Clinic Liver Cancer (BCLC) stage 0 and A patients were 42.0%, B for 14.5%, C for 40.8%, and D for 2.7%. Most (85.4%) had Child-Pugh class A. Hepatitis B e antigen-positive patients was 36.3%. There were no differences between ETV and TDF groups in the baseline characteristics. During a median follow-up period of 28.0 months (range: 0.1 - 92.1 months), 441 (42.8%) patients died. Entecavir group and tenofovir group did not show any difference in overall survival (median 28.0 vs 29.0 months, P=0.972). When stratified with BCLC stage, the results were similar. By both univariable and multivariable cox regression analysis, the type of NA was not an independent factor for overall survival, while male sex, albumin-bilirubin grade, fibrosis-4 score, serum alpha-fetoprotein, and BCLC stage were revealed to be significant factors. Conclusions: Among antiviral treatment-naïve patients newly diagnosed with HBV-related HCC, ETV and TDF therapy did not differ for overall survival.
( Myung Ji Goh ),( Joo Hyun Oh ),( Yewan Park ),( Jihye Kim ),( Dong Hyun Sinn ),( Wonseok Kang ),( Geum-youn Gwak ),( Yong-han Paik ),( Moon Seok Choi ),( Joon Hyeok Lee ),( Kwang Cheol Koh ),( Seung 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Some young adults with chronic hepatitis B virus (HBV) infection might be at high risk for hepatocellular carcinoma (HCC), enough to justify regular HCC surveillance despite the young age of the patients. However, ways to identify at-risk individuals who may benefit from HCC surveillance need further evaluations. Methods: A hospital-based retrospective cohort of 2,612 chronic HBV mono-infected young adults (median age: 36 years, males 46%) were analyzed. The primary outcome was the development of HCC at a young age. Young-onset HCC was defined in males aged < 40 and females aged < 50 years. We calculated the HCC incidence/1000 person-years in the overall cohort and pre-defined subgroups of patients, assessed the independent risk factors, and tested criteria that can be used to identify surveillance targets. Results: The HCC incidence was low (2.89/1000 person-years) in the overall cohort. However, the HCC incidence varied widely according to baseline characteristics: lowest among young adults with FIB-4 ≤ 0.70 (0.22/1000 person-years), and highest in young adults with radiological cirrhosis (22.5/1000 person-years). The sensitivity of radiologic cirrhosis was sub-optimal (73.5%) for identifying young adults who may develop young-onset HCC. When the FIB-4 index was added, the sensitivity increased (91.2%) with an acceptable tradeoff in specificity (89.5% to 85.9%). Conclusions: Among young Asian adults with chronic HBV infections, some subgroups were at high risk of developing young-onset HCC that justify HCC surveillance, and could be identified by using FIB-4 index, along with radiologic cirrhosis.
Choi Won Joon,Kim Gi-Ae,Park Jaewon,Jang Sangmi,Jung Woo Jin,Shim Jae-Jun,Park Yewan,Choi Gwang Hyeon,Kim Jin-Wook,Jeong Sook-Hyang,Jang Eun Sun 대한의학회 2022 Journal of Korean medical science Vol.37 No.33
Background: Angiotensin type II receptor blockers (ARBs) are the most widely used antihypertensive drugs. This study aimed to elucidate the likelihood and pattern of ARB-induced liver injury in a hospital-based cohort. Methods: Data of patients receiving fimasartan (n = 5,543), candesartan (n = 6,406), valsartan (n = 6,040), and losartan (n = 9,126) were retrieved from the clinical data warehouse of two tertiary hospitals. Patients with alanine aminotransferase (ALT) levels > 5 times the upper normal limit were assessed according to the Roussel Uclaf Causality Assessment Method (RUCAM). Results: A total of 27,115 patients were enrolled, including 14,630 (54.0%) men, with a mean age of 64.6 years (standard deviation, 13.6). During 31,717 person-years of ARB therapy, serum ALT levels > 120 IU/L were found in 558 (2.1%) person-years, and levels > 200 IU/L were found in 155 (0.6%) person-years. The incidence of ALT elevation > 120 IU/L per 106 cumulative defined daily doses was 6.6, 3.6, 3.9, and 4.0 in the fimasartan, candesartan, valsartan, and losartan groups, respectively (P = 0.002). An ALT level > 200 IU/L with RUCAM score ≥ 6 was found in 20 patients, suggesting probable drug-induced liver injury for 11 (0.2%) patients receiving fimasartan, five (0.1%) receiving candesartan, four (0.1%) receiving valsartan, and none receiving losartan (P < 0.001). Conclusion: Approximately 2% of patients receiving ARB therapy had significant ALT elevation (4.24/106 cumulative defined daily doses [cDDDs]), which was associated with probable ARB-related liver injury in 0.07% of patients (0.15/106 cDDDs). Elevation of ALT was more commonly associated with fimasartan than the other ARBs. Clinicians should be aware of the possibility of ARB-related ALT elevation in patients with unexplained chronic abnormal ALT.