Hepatitis B virus‐related hepatocellular carcinoma in young adults: Efficacy of nationwide selective vaccination

Abstract

Aim Hepatitis B vaccination in infancy was carried out in Japan only when the mother was persistently infected from 1986 to 2016. The aim of the present study was to elucidate the results of vaccination for the prevention of hepatocellular carcinoma in young adults. Methods We studied the number of patients who had liver cancer and died from 1976 to 2017 using a national database. Furthermore, we carried out a nationwide survey focusing on patients with hepatitis B virus‐related hepatocellular carcinoma who were diagnosed when aged <40 years from 2007 to 2016. Results The national database showed that the number of deaths of patients aged <40 years decreased from 337 in 1986 to 61 in 2016. Among the 122 patients with hepatocellular carcinoma (HCC) who were registered in the survey, just three patients were born after the start of the vaccination in 1986. Liver cirrhosis, defined by a high Fib‐4 index (≥3.25), was found in just 12.5% of the patients at the time of the survey. HCC was incidentally diagnosed in 85 of the 122 (69%) patients. More than 60% of the patients (54/88) were dead at the time of the study, which may be attributed to the delay in diagnosis. Conclusions Selective vaccination was effective for the prevention of hepatitis B virus‐related HCC. In contrast, many young adults who missed the chance of hepatitis B vaccination and HCC surveillance developed HCC and died. Hepatitis B virus screening in young adults and careful follow up of infected patients are important to prevent HCC development.

Serum fibrosis index-based risk score predicts hepatocellular carcinoma in untreated patients with chronic hepatitis B

“…APRI >2 was not associated with HCC development in both univariate and multivariable analysis ( Supplementary Table 3 ). FIB-4 >3.25, male gender, age older than 50 years old, high total bilirubin (bilirubin >18 µmol/L), low platelet (platelet <150×10 9 /L), high HBV DNA level (HBV DNA >2,000 IU/mL) and DM were correlated with HCC development by univariate analysis [ 29 ]. There were 2,155 patients (14.2%) without FIB-4 index and these patients were excluded from the Cox proportional hazards model.…”

“…FIB-4 >3.25, male gender, age older than 50 years old, high total bilirubin (bilirubin > 18 µmol/L), low platelet (platelet < 150 (×10 9 /L), high HBV DNA level (HBV DNA > 2000 IU/mL) and DM were correlated with HCC development by univariate analysis. 29 There were 2155 (14.2%) patients without FIB-4 index and these patients were excluded from the Cox proportional hazards model. Male gender, age older than 50, high HBV DNA level and high FIB-4 could predict HCC development significantly in multivariable analysis ( Table 2).…”

HBV induces liver fibrosis via the TGF‑β1/miR‑21‑5p pathway

“…HBV also ranks first among the causes of liver fibrosis in China, infecting ~7% of the entire population (30). At present, although anti-HBV treatment has limited success, chronic HBV infection gradually leads to the development of liver fibrosis and even liver cancer (31,32).…”

The Effect of the Hepatitis B Vaccine Derived from Genotype C on Infants Born to Mothers Infected with Genotype D

“…In Japan, genotype C-and genotype A-derived vaccines are used in the nationwide project for mother-to-child transmission prevention. Based on epidemiological data, after the introduction of this project, regarding the decreased rate of HBV carriers and the decreased incidence of hepatocellular carcinoma in young adults, it is suspected that these two types of vaccines are effective at pre- venting the transmission of genotypes B and C, the domestic genotypes in Japan (5,6,20). However, the above epidemiological data is insufficient to clarify whether the genotype C-derived vaccine is effective at preventing transmission of genotype D, as genotype D is a minor genotype in Japan, and there is currently no published research regarding the effect of the genotype C-derived vaccine on the prevention of mother-to-child transmission to children born to mothers infected with genotype C. Moreover, reports were scarcely found regarding the efficacy of universal vaccination using genotype-C-derived vaccines in areas or countries where genotype D is circulating predominantly (21).…”