Incidence and Risk Factors for Hepatocellular Carcinoma in Young Age in Patients with Chronic Hepatitis B Viral Infection = Incidence and Risk Factors for Hepatocellular Carcinoma in Young Age in Patients with Chronic Hepatitis B Viral Infection

다국어 초록 (Multilingual Abstract)

Aims: Some young adults with chronic hepatitis B virus (HBV) infection might be at high risk for hepatocellular carcinoma (HCC), enough to justify regular HCC surveillance despite the young age of the patients. However, ways to identify at-risk individuals who may benefit from HCC surveillance need further evaluations.
Methods: A hospital-based retrospective cohort of 2,612 chronic HBV mono-infected young adults (median age: 36 years, males 46%) were analyzed. The primary outcome was the development of HCC at a young age. Young-onset HCC was defined in males aged < 40 and females aged < 50 years. We calculated the HCC incidence/1000 person-years in the overall cohort and pre-defined subgroups of patients, assessed the independent risk factors, and tested criteria that can be used to identify surveillance targets.
Results: The HCC incidence was low (2.89/1000 person-years) in the overall cohort. However, the HCC incidence varied widely according to baseline characteristics: lowest among young adults with FIB-4 ≤ 0.70 (0.22/1000 person-years), and highest in young adults with radiological cirrhosis (22.5/1000 person-years). The sensitivity of radiologic cirrhosis was sub-optimal (73.5%) for identifying young adults who may develop young-onset HCC. When the FIB-4 index was added, the sensitivity increased (91.2%) with an acceptable tradeoff in specificity (89.5% to 85.9%).
Conclusions: Among young Asian adults with chronic HBV infections, some subgroups were at high risk of developing young-onset HCC that justify HCC surveillance, and could be identified by using FIB-4 index, along with radiologic cirrhosis.