Research indicates a nonlinear relationship between serum hepatitis B virus (HBV) DNA levels and the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). A new prognostic model that analyzes this relationship serves as an important tool for predicting and stratifying HCC risk in noncirrhotic patients with CHB who are not currently eligible for antiviral treatment.
During median follow-up periods of 10.0 and 12.2 years, the derivation and validation groups identified 435 and 467 new cases of HCC, respectively. The baseline HBV DNA level was one of the strongest predictors of HCC risk, showing a nonlinear relationship in both groups, with moderate viral loads (around 6 log10 IU/mL) linked to the highest risk.
This multinational cohort investigation utilized a community-based cohort in Taiwan, encompassing the REVEAL-HBV and REACH-B models, along with eight hospital-based cohorts from Korea and Hong Kong, including the GAG-HCC and CU-HCC cohorts.
Main Takeaways
- Research shows a nonlinear relationship between serum HBV DNA levels and HCC risk in CHB patients, highlighting the importance of monitoring viral loads.
- A new prognostic model that incorporates factors such as age, sex, and platelet count effectively predicts and stratifies HCC risk in noncirrhotic patients with CHB.
- Studies on LOXL2 suggest that combining LOXL2 and AFP levels can improve HCC risk assessment, emphasizing the need for tailored surveillance strategies for patients with chronic liver diseases.
Other factors included in the new model (Revised REACH-B) were age, sex, platelet count,alanine aminotransferase (ALT) levels, and a positive hepatitis B e antigen result. The model demonstrated good discrimination and accuracy, with c-statistics of .844 and .813 for the derivation and validation groups, respectively. It provided a greater positive net benefit compared to other methods within a risk threshold of 0% to 18%. Validation in cohorts of different races and those undergoing antiviral treatment was not performed.
For model development, 6,949 patients with CHB were selected from a Korean hospital-based cohort, while external validation involved 7,429 patients from the Taiwanese cohort and seven additional cohorts from Korea and Hong Kong. The findings aim to enhance risk evaluation and management strategies for HCC in CHB patients.
Similarly, recent research shows that lysyl oxidase-like 2 (LOXL2) levels could serve as a predictor for HCC risk in hepatitis C virus (HCV) patients who have achieved sustained virological response (SVR). Both studies focus on identifying biomarkers that can predict the development of HCC in patients with chronic liver conditions. Specifically, the HBV study emphasizes the importance of serum HBV DNA levels, while the LOXL2 study highlights the role of LOXL2 and alpha-fetoprotein (AFP) levels in assessing HCC risk.
Both studies reveal nonlinear relationships, the HBV research notes a complex association between viral loads and HCC risk, while the LOXL2 findings indicate that post-treatment levels correlate with HCC risk, suggesting intricate interactions in both scenarios. Each study aims to enhance surveillance and management strategies for early HCC detection. By incorporating various factors into their predictive models, these studies emphasize the need for ongoing monitoring of these biomarkers to identify high-risk patients and adjust treatment strategies accordingly.
Overall, while the specific viruses and biomarkers differ, the shared goal of improving risk prediction and management of HCC in patients with chronic liver disease unites these investigations.
References
Gi-Ae Kim, Young-Suk Lim, Seungbong Han, et al. Viral Load–Based Prediction of Hepatocellular Carcinoma Risk in Noncirrhotic Patients With Chronic Hepatitis B: A Multinational Study for the Development and External Validation of a New Prognostic Model. Ann Intern Med. Epub 17 September 2024. Accessed September 18, 2024. doi: 10.7326/M24-0384
Chida T, Ohta K, Noritake H, et al.Lysyl oxidase-like 2 as a predictor of hepatocellular carcinoma in patients with hepatitis C virus after sustained virological response. Sci Rep. Published May 13, 2024. Accessed September 18, 2024. doi: https://doi.org/10.1038/s41598-024-61366-y
