Differential HCC risk among HBV indeterminate types at baseline and by phase transition

作者：Rui Huang, Huy N. Trinh, Satoshi Yasuda, Angela Chau, Mayumi Maeda, Ai‐Thien Do, Daniel Q. Huang, Takanori Ito, Takashi Honda, Masatoshi Ishigami, Ritsuzo Kozuka, Carmen Monica Preda, Cheng-Hao Tseng, Sebastián Marciano, Pei‐Chien Tsai, Dong Hyun Lee, Christopher Wong, Son Do, Keigo Kawashima, Jian Zhang, Raluca Ioana Marin, Irina Sandra, Jiayi Li, Eiichi Ogawa, Ramsey Cheung, Jie Li, Ming‐Lung Yu, Adrián Gadano, Yao‐Chun Hsu, María Buti, Masaru Enomoto, Seng Gee Lim, Chao Wu, Hidenori Toyoda, Mindie H. Nguyen · 发表于：Gut · 年份：2025 · DOI：10.1136/gutjnl-2025-335033 · 被引用次数：8 · 研究领域：Hepatitis B Virus Studies、Hepatitis C virus research、Liver Disease Diagnosis and Treatment

BACKGROUND: Patients with chronic hepatitis B (CHB) with indeterminate phase make up a diverse cohort with likely different outcomes. OBJECTIVE: We compared the hepatocellular carcinoma (HCC) risk in indeterminate CHB with different baseline types and by phase transition. DESIGN: This was a retrospective cohort study of 1986 (94.2% Asian) patients with indeterminate CHB from nine countries/regions. Patients were classified according to baseline hepatitis B e-antigen (HBeAg), alanine aminotransferase (ALT) and HBV DNA. The cumulative HCC incidence was compared. RESULTS: IU/mL, 36.2%) and lowest in type 8 (HBeAg negative, ALT 1-2×ULN, HBV DNA<2000 IU/mL, 1.9%). The 20-year HCC incidence of those who remained indeterminate was 4.7%. Cumulative HCC incidence rates were high in patients with indeterminate CHB who transitioned to immune tolerant (15 years: 16.5%) or immune active (20 years: 13.7%) phase but low for those who transitioned to immune inactive phase (20 years: 2.5%). In multivariable analysis, compared with type 8, higher HCC risk was seen with HBeAg-positive type 1 (adjusted HR (aHR)=40.1, p<0.001), type 2 (ALT 1-2×ULN, HBV DNA≥20 000 IU/mL, aHR=25.1, p<0.001), HBeAg-negative type 9 (ALT>2×ULN, HBV DNA<2000 IU/mL, aHR=4.6, p=0.032) and type 10 (ALT<1×ULN, HBV DNA<2000 IU/mL but with moderate to severe inflammation/fibrosis, aHR=7.3, p=0.033). Similar directions in HCC risks were found in analyses based on the 2017 European Association for the Study of the Liver guidel...