Hepatocellular Carcinoma Risk of Compensated Cirrhosis Patients with Elevated HBV DNA Levels according to Serum Aminotransferase Levels|RISS 상세보기

다국어 초록 (Multilingual Abstract)

Sometimes, hepatitis B virus (HBV)-related cirrhotic patients with normal aminotransferase levels are closely followed-up for the elevation of aminotransferase levels instead of prompt antiviral therapy (AVT). We analyzed the long-term hepatocellular carcinoma (HCC) risk according to the aminotransferase levels in a retrospective cohort of 1,468 treatmentnaïve, HBV-related, compensated cirrhosis patients with elevated HBV DNA levels (≥ 2,000 IU/mL). Based on aminotransferase levels, patients were categorized into normal (< 40 U/L, n = 364) and elevated group (≥40 U/L, n = 1,104). During a median of 5.3 yr of follow-up (range: 1.0-8.2 yr), HCC developed in 296 (20%) patients. The 5-yr cumulative HCC incidence rate was higher in patients with elevated aminotransferase level, but was not low in normal aminotransferase level (17% vs. 14%, P = 0.004). During the follow-up, 270/364 (74%) patients with normal aminotransferase levels experienced elevation of aminotransferase levels, and AVT was initiated in 1,258 (86%) patients. Less patients with normal aminotransferase levels received AVT (70% vs. 91%, P < 0.001) and median time to start AVT was longer (17.9 vs. 2.4 months, P < 0.001). AVT duration was an independent factor associated with HCC, and median duration of AVT was shorter (4.0 vs. 2.6 yr, P < 0.001) in patients with normal aminotransferase levels. The HCC risk of compensated cirrhosis patients with normal aminotransferase level is not low, and AVT duration is associated with lowered HCC risk, indicating that prompt AVT should be strongly considered even for those with normal aminotransferase levels.

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참고문헌 (Reference)

1 Park HN, "Upper normal threshold of serum alanine aminotransferase in identifying individuals at risk for chronic liver disease" 32 : 937-944, 2012

2 Prati D, "Updated definitions of healthy ranges for serum alanine aminotransferase levels" 137 : 1-10, 2002

3 Yang BM, "The societal burden of HBV-related disease : South Korea" 55 : 784-793, 2010

4 Lai M, "The clinical significance of persistently normal ALT in chronic hepatitis B infection" 47 : 760-767, 2007

5 Marcellin P, "Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B : a 5-year open-label follow-up study" 381 : 468-475, 2013

6 Korean Liver Cancer Study Group, "Practice guidelines for management of hepatocellular carcinoma 2009" 15 : 391-423, 2009

7 Cho JY, "Patients with chronic hepatitis B treated with oral antiviral therapy retain a higher risk for HCC compared with patients with inactive stage disease" 63 : 1943-1950, 2014

8 Sung JJ, "Meta-analysis : Treatment of hepatitis B infection reduces risk of hepatocellular carcinoma" 28 : 1067-1077, 2008

9 Bruix J, "Management of hepatocellular carcinoma : an update" 53 : 1020-1022, 2011

10 "KASL Clinical Practice Guidelines: Management of chronic hepatitis B" 18 : 109-162, 2012