SNFGE SNFGE
 
Thématique :
- Foie
- Carcinome hépatocellulaire (CHC)
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2018/08  
 
  2018 Aug;68(2):462-472.  
  doi: 10.1002/hep.29874  
 
  Long-term outcomes and predictive scores for hepatocellular carcinoma and hepatitis B surface antigen seroclearance after hepatitis B e-antigen seroclearance.  
 
  Fung J, Cheung KS, Wong DK, Mak LY, To WP, Seto WK, Lai CL, Yuen MF  
  https://www.ncbi.nlm.nih.gov/pubmed/29534307  
 
 

Abstract
 

The significance of hepatitis B e-antigen (HBeAg) seroclearance (ESC) in the long term is not well defined. The current study aimed to determine the clinical outcomes, the factors and predictive scores for hepatocellular carcinoma (HCC), and hepatitis B surface antigen (HBsAg) seroclearance of a large cohort of patients undergoing ESC. Patients with documented ESC were followed up 3- to 6-monthly. Baseline characteristics and longitudinal laboratory results were recorded. Predictive scores for HCC (HCC-ESC) and HBsAg seroclearance (HBsAg-ESC) were derived from multivariate Cox regression models. A total of 723 patients underwent ESC with a median ESC age and follow-up of 36.0 and 18.3 years, respectively. Only 3.5% and 3.0% had persistently normal alanine aminotransferase (ALT) and HBV DNA <2logs IU/mL, respectively, after ESC. For patients with 100%, 100%-90%, 90%-50%, 50%-10%, 10%-0%, and 0% normal ALT after HBeAg seroclearance, the rate of HCC was 4.3%, 2.2%, 3.6%, 3.9%, 17.3%, and 37.2% at 20 years after ESC, respectively (P < 0.001). At 20 years after ESC, the cumulative incidence of HCC and HBsAg seroclearance was 7.9% and 13.5%, respectively, with an overall survival of 91.5%. ESC age, male sex, cirrhosis, hypoalbuminemia, viral load, and ALT were significant factors for HCC, whereas ESC age, male sex, viral load, and antiviral therapy were significant factors for HBsAg seroclearance. The area under receiver operating characteristics for HCC-ESC and HBsAg-ESC scores to predict HCC and HBsAg seroclearance at 20 years after ESC was 0.92 and 0.74, respectively.

CONCLUSION:

Male sex, older age at ESC, ALT, and higher level of HBV DNA were associated with higher rates of HCC after ESC. HCC-ESC and HBsAg-ESC predictive scores can determine the likelihood of developing HCC and achieving HBsAg seroclearance. (Hepatology 2018).

 
Question posée
 
Déterminer l’évolution clinique, les facteurs et les scores prédictifs de carcinome hépatocellulaire (CHC), et de clairance de l’AgHBs dans une large cohorte de patients avec clairance l’AgHBe (ESC).
 
Question posée
 
Le genre masculin, l’âge, l’ALAT et un taux d’ADN VHB plus élevé sont associés à taux plus élevés de CHC après ESC.
 
Commentaires

Surtout vrai pour les patients asiatiques et agHBe positif mais pas très nouveau.

 
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