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Abstract
Chronic hepatitis B patients are at increased risk for hepatocellular carcinoma (HCC).
The effect of medium-term nucleos(t)ide analogue therapy on HCC incidence is unclear;
therefore, we systematically reviewed all the data on HCC incidence from studies in
chronic hepatitis B patients treated with nucleos(t)ide analogues.
We performed a literature search to identify studies with chronic hepatitis B patients
treated with nucleos(t)ide analogues for> or = 24 months.
Twenty-one studies including 3881 treated and 534 untreated patients met our inclusion
criteria. HCC was diagnosed in 2.8% and 6.4% of treated and untreated patients, respectively,
during a 46 (32-108) month period (p=0.003), in 10.8% and 0.5% of nucleos(t)ide naive
patients with and without cirrhosis (p<0.001) and in 17.6% and 0% of lamivudine resistance
patients with and without cirrhosis (p<0.001). HCC developed less frequently in nucleos(t)ide
naive patients compared to those without virological remission (2.3% vs 7.5%, p<0.001),
but there was no difference between lamivudine resistance patients with or without
virological response to rescue therapy (5.9% vs 8.8%, p=0.466).
Chronic hepatitis B patients receiving medium-term nucleos(t)ide analogue therapy
had a significantly lower incidence of HCC compared to untreated patients but treatment
does not completely eliminate the risk of HCC. Among the treated patients, cirrhosis,
HBeAg negative at baseline and failure to remain in virological remission were associated
with an increased risk of HCC.
Copyright 2010 European Association for the Study of the Liver. Published by Elsevier
B.V. All rights reserved.