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Abstract Details |
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Progression Rates by Age, Sex, Treatment, and Disease Activity by AASLD and EASL Criteria: Data for Precision Medicine |
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Clin Gastroenterol Hepatol. 2021 Jun 2;S1542-3565(21)00601-7. doi: 10.1016/j.cgh.2021.05.062.Online ahead of print.
Jiyoon Park 1, An K Le 2, Tai-Chung Tseng 3, Ming-Lun Yeh 4, Dae Won Jun 5, Huy Trinh 6, Grace Lh Wong 7, Chien-Hung Chen 8, Cheng-Yuan Peng 9, Sung Eun Kim 10, Hyunwoo Oh 11, Min-Sun Kwak 11, Ka Shing Cheung 12, Hidenori Toyoda 13, Yao-Chun Hsu 14, Jae Yoon Jeong 15, Eileen L Yoon 16, Teerapat Ungtrakul 17, Jian Zhang 18, Qing Xie 19, Sang Bong Ahn 20, Masaru Enomoto 21, Jae-Jun Shim 22, Chris Cunningham 23, Soung Won Jeong 24, Yong Kyun Cho 25, Eiichi Ogawa 26, Rui Huang 27, Dong-Hyun Lee 28, Hirokazu Takahashi 29, Pei-Chien Tsai 4, Chung-Feng Huang 5, Chia-Yen Dai 5, Cheng-Hao Tseng 14, Satoshi Yasuda 13, Ritsuzo Kozuka 21, Jiayi Li 30, Christopher Wong 31, Clifford C Wong 31, Changqing Zhao 32, Joseph Hoang 33, Yuichiro Eguchi 29, Chao Wu 27, Yasuhito Tanaka 34, Ed Gane 35, Tawesak Tanwandee 36, Ramsey Cheung 33, Man-Fung Yuen 12, Hyo-Suk Lee 11, Ming-Lung Yu 4, Jia-Horng Kao 3, Hwai-I Yang 37, Mindie H Nguyen 38
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Author information
- 1Department of Medicine, Santa Clara Valley Medical Center, Santa Clara, CA, USA; Division of Gastroenterology and Hepatology, Stanford University Medical Center, CA, USA.
- 2Division of Gastroenterology and Hepatology, Stanford University Medical Center, CA, USA.
- 3Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- 4Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
- 5Department of Gastroenterology, Hanyang University College of Medicine, Seoul, Republic of Korea.
- 6San Jose Gastroenterology, San Jose, CA, USA.
- 7Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR, China.
- 8Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
- 9Department of Gastroenterology, China Medical University Hospital, Taichung, Taiwan.
- 10Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
- 11Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
- 12Department of Medicine, the University of Hong Kong, Hong Kong SAR, China.
- 13Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
- 14Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
- 15Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea.
- 16Department of Internal Medicine, Sanggye Paik Hospital, Inje University Seoul, Republic of Korea.
- 17Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Thailand.
- 18Chinese Hospital, San Francisco, CA, USA.
- 19Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PRC.
- 20Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea.
- 21Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
- 22Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
- 23Research Centre for Maori Health and Development, Massey University, Wellington, New Zealand.
- 24Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
- 25Department of Internal Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
- 26Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
- 27Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, PRC.
- 28Department of Gastroenterology, Good Gang-An Hospital, Busan, Republic of Korea.
- 29Department of Internal Medicine, Saga University Hospital, Saga, Japan.
- 30Palo Alto Medical Foundation, Mountain View Division, Mountain View, CA, USA.
- 31Wong Clinics, San Francisco, CA, USA.
- 32Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital affiliated to Shanghai University of T.C.M., Shanghai, PRC.
- 33Department of Medicine, Santa Clara Valley Medical Center, Santa Clara, CA, USA.
- 34Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
- 35New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
- 36Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
- 37Genomics Research Center, Academia Sinica, Taipei, Taiwan.
- 38Division of Gastroenterology and Hepatology, Stanford University Medical Center, CA, USA; Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA. Electronic address: mindiehn@stanford.edu.
Abstract
Background: Antiviral treatment criteria are based on disease progression risk, and hepatocellular carcinoma (HCC) surveillance recommendations for patients with chronic hepatitis B (CHB) without cirrhosis is based on an annual incidence threshold of 0.2%. However, accurate and precise disease progression estimate data are limited. Thus, we aimed to determine rates of cirrhosis and HCC development stratified by age, sex, treatment status and disease activity based on the 2018 AASLD and 2017 EASL guidelines.
Methods: We analyzed 18,338 patients (8914 treated; 9424 untreated) from 6 centers from the US and 27 centers from Asia Pacific countries. The Kaplan-Meier method was used to estimate annual progression rates to cirrhosis or HCC in person-years.
Results: The cohort was 63% male, with a mean age of 46.19 years, baseline cirrhosis of 14.3%, and median follow up of 9.60 years. By AASLD criteria, depending on age, sex, and disease activity, annual incidence rates ranged from 0.07%-3.94% for cirrhosis, from 0.04%-2.19% for HCC in patients without cirrhosis, and 0.40%-8.83% for HCC in patients with cirrhosis. Several subgroups of patients without cirrhosis including males younger than 40 and females younger than 50 had annual HCC risk near or exceeding 0.2%. Similar results were found using EASL criteria.
Conclusion: There is great variability in CHB disease progression rates even among "lower risk" populations. Future CHB modeling studies, public health planning, and HCC surveillance recommendation should be based on more precise disease progression rates based on sex, age, disease activity, plus treatment status.
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