Hepatocellular carcinoma progression in hepatitis B virus-related cirrhosis patients receiving nucleoside (acid) analogs therapy: A retrospective cross-sectional study

Abstract

BACKGROUND Antiviral therapy cannot completely block the progression of hepatitis B to hepatocellular carcinoma (HCC). Furthermore, there are few predictors of early HCC progression and limited strategies to prevent progression in patients with HBV-related cirrhosis who receive nucleos(t)ide analog (NA) therapy. AIM The study aim was to clarify risk factors and the diagnostic value of alpha-fetoprotein (AFP) for HCC progression in NA-treated hepatitis B virus (HBV)-related cirrhosis patients. METHODS In this retrospective cross-sectional study, we analyzed the clinical data of 266 patients with HBV-related cirrhosis who received NA treatment between February 2014 and April 2020 at Zhejiang Provincial People’s Hospital. The patients were divided into two groups, 145 who did not progress to HCC (No-HCC group), and 121 who progressed to HCC during NA treatment (HCC group). The logistic regression analysis was used to analyze the risk factors of HCC progression. The diagnostic value of AFP for HCC was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS Univariate analysis showed that age ≥ 60 years ( P = 0.001), hepatitis B and alcoholic etiology ( P = 0.007), smoking history ( P < 0.001), family history of HBV-related HCC ( P = 0.002), lamivudine resistance ( P = 0.011), HBV DNA negative ( P = 0.023), aspartate aminotransferase > 80 U/L ( P = 0.002), gamma-glutamyl transpeptidase > 120 U/L ( P = 0.001), alkaline phosphatase > 250 U/L ( P = 0.001), fasting blood glucose (FBG) ≥ 6.16 (mmol/L) ( P = 0.001) and Child-Pugh class C ( P = 0.005) were correlated with HCC progression. In multivariate analysis, age ≥ 60 years [hazard ratio (HR) = 3.089, 95% confidence interval (CI): 1.437-6.631, P = 0.004], smoking history (HR = 4.001, 95%CI: 1.836-8.716, P < 0.01), family history of HBV-related HCC (HR = 6.763, 95%CI: 1.253-36.499, P < 0.05), lamivudine resistance (HR = 2.949, 95%CI: 1.207-7.208, P = 0.018), HBV DNA negative (HR = 0.026, 95%CI: 0.007-0.139, P < 0.01), FBG ≥ 6.16 mmol/L (HR = 7.219, 95%CI: 3.716-14.024, P < 0.01) were independent risk factors of HCC progression. ROC of AFP for diagnosis of HCC was 0.746 (95%CI: 0.674-0.818). A cutoff value of AFP of 9.00 ug/L had a sensitivity of 0.609, and specificity of 0.818 for diagnosing HCC. CONCLUSION Age ≥ 60 years, smoking history, family history of HCC, lamivudine resistance, HBV DNA negative, FBG ≥ 6.16 mmol/L were risk factors of HCC progression. Serum AFP ha...

Female and Diabetes are risk factors for Alpha-fetoprotein and Vitamin K deficiency or antagonist -II negative in Hepatocellular Carcinoma

“…Furthermore, higher PIVKA-II levels in non-viral HCC patients may result from more rigorous ultrasound surveillance, leading to the detection of more advanced disease at the time of initial diagnosis [28]. Previous studies have indicated a positive correlation between both AFP and PIVKA-II levels and tumor size [29][30][31]. Consistent with these ndings, our study identi ed tumor size as an independent factor associated with abnormally elevated levels of PIVKA-II and AFP in HCC patients.…”

Serum alpha-fetoprotein as a predictive biomarker for tissue alpha-fetoprotein status and prognosis in patients with hepatocellular carcinoma

“…AFP is the most widely used biomarker for HCC, even though it has been reported that up to 20% of HCC patients’ tumor cells do not secrete AFP proteins ( 4 ). A previous study reported that a cutoff value of AFP of 90.0 ng/mL had a sensitivity of 0.609, and specificity of 0.818 for diagnosing HCC in 121 enrolled patients, and the receiver operating characteristic (ROC) curve of AFP for diagnosis of HCC was 0.746 (95% CI: 0.674–0.818) ( 5 ). Serum AFP level can indirectly reflect the ability of tumor cells to synthesize and process AFP protein.…”