Incidence and risk factors for development of hepatocellular carcinoma at young age in patients with chronic hepatitis B

Abstract

Background

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 2757 chronic HBV mono-infected young adults (median age: 34 years, males 66%) were analyzed. The primary outcome was young-onset HCC, defined as a diagnosis made under 40 years of age. We calculated the HCC incidence/1000 person-years in the overall cohort and pre-defined subgroups of patients assessed the independent risk factors that can be used to identify surveillance targets.

Results

The HCC incidence was low (2.55/1000 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 (0.17/1000 person-years) and highest in young adults with radiological cirrhosis (30.7/1000 person-years). In multivariable analysis, radiological cirrhosis, the FIB-4 index, and serum HBV DNA level were independent factors associated with HCC development at a young age. Performance for prediction of young-onset HCC in radiological cirrhotic patients showed the highest specificity but sensitivity was <70%. Combination with FIB-4 index and HBV DNA levels increased sensitivity to 90%.

Conclusion

Risk stratification using FIB-4 index, HBV DNA levels, and either combining radiological cirrhosis or gender and AFP levels would be helpful to stratify young patients who would and would not benefit from regular HCC surveillance.

Keywords:

• Hepatocellular carcinoma
• surveillance
• FIB-4
• young
• chronic hepatitis B

Author contributions

M.J.G.: study design, statistical analysis, and drafting of the manuscript. W.K.: study design, study supervision, and critical revision of the manuscript. K.M.K.: study supervision and critical revision of the manuscript. D.H.S.: study design, interpretation, and critical revision of the manuscript. G.Y.G.: study design, study supervision, and critical revision of the manuscript. Y.H.P.: study design, drafting of the manuscript, and study supervision. M.S.C.: study design, study supervision, and critical revision of the manuscript. J.H.L.: study supervision, statistical analysis, and data interpretation. K.C.K.: study design, study supervision, and data interpretation. S.W.P.: study supervision, data interpretation, and critical revision of the manuscript.

Disclosure statement

No potential conflict of interest relevant to this article was reported.

Additional information

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (NRF-2016R1C1B2015463 and NRF2019R1C1C1007729).