Overview
Hepatocellular carcinoma (HCC) is a significant cause of mortality, with rising rates in some regions 2. Surveillance is recommended to increase early diagnosis, particularly in patients with chronic viral hepatitis and cirrhosis 2.Diagnosis
Risk prediction models for HCC in patients with chronic hepatitis B (CHB) on antiviral therapy have a pooled area under the receiver operating characteristic (AUROC) of 0.72 for 3-year prediction and 0.80 for 5-year prediction 3.
Hepatitis B virus core-related antigen (HBcrAg) positivity has been identified as an independent risk factor for HCC development in CHB patients, with hazard ratios ranging from 3.27 to 7.05 4.Management
Immune checkpoint inhibitors (ICIs) are used in HCC treatment 1.
The load of hepatitis B virus (HBV) does not appear to significantly impact the efficiency of ICIs in HCC patients regarding overall survival or progression-free survival 1.
HBV-infected patients with HCC may have better tumor response to ICIs than non-HBV infected patients 1.Key Recommendations
HCC surveillance programs in primary care should include additional support for primary care providers and strategies to increase awareness of clinical recommendations 2.
Risk prediction scores for HCC in patients with CHB on antivirals are useful for mid-long term prediction 3.
Hepatitis B virus core-related antigen (HBcrAg) may serve as a prognostic marker for HCC development in CHB patients 4.
The association between HBV infection and ICI efficiency in HCC patients does not significantly affect mortality or progression risk 1.References
1 Ji Z, Li J, Zhang S, Jia Y, Zhang J, Guo Z. The load of hepatitis B virus reduces the immune checkpoint inhibitors efficiency in hepatocellular carcinoma patients. Frontiers in immunology 2024. link
2 Nguyen ALT, Milley K, Druce P, Qama A, McNamara M, Wong J et al.. Surveillance for liver cancer in primary care: A systematic review of the evidence. Australian journal of general practice 2023. link
3 Shen Y, Liu J, Han Z, Jiang W, Cui H, Xun Y. Risk prediction models for hepatocellular carcinoma in chronic hepatitis B patients on antiviral therapy: A meta-analysis. Clinics and research in hepatology and gastroenterology 2022. link
4 Afifi AM, Elgenidy A, Hashim M, Awad AK, Jalal PK. Hepatitis B virus core-related antigen (HBcrAg) as a prognostic marker for the development of hepatocellular carcinoma: A mini systematic review of the literature. Reviews in medical virology 2022. link