Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 28, 2013; 19(40): 6834-6841
Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6834
Risk factors for hepatocellular carcinoma in patients with drug-resistant chronic hepatitis B
Chung Hwan Jun, Hyoung Ju Hong, Min Woo Chung, Seon Young Park, Sung Bum Cho, Chang Hwan Park, Young Eun Joo, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew
Chung Hwan Jun, Hyoung Ju Hong, Min Woo Chung, Seon Young Park, Sung Bum Cho, Chang Hwan Park, Young Eun Joo, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew, Department of Internal Medicine, Chonnam National University Medical School, Gwangju 501-757, South Korea
Author contributions: Jun CH and Choi SK performed the majority of the study and wrote the manuscript; Cho SB, Park SY, and Park CH were involved in editing the manuscript; and Hong HJ and Chung MW were involved in data acquisition, analysis and interpretation; all authors were involved in revising and approving the final version for publication.
Supported by Grants from Chonnam National University Hospital 42, Jaebong-ro, Dong-Ku, Gwangju, 501-757, South Korea
Correspondence to: Sung Kyu Choi, MD, Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 42, Jaebong-ro, Dong-Ku, Gwangju 501-757, South Korea. estevanj@naver.com
Telephone: +82-62-2206296 Fax: +82-62-2258578
Received: June 18, 2013
Revised: August 10, 2013
Accepted: September 3, 2013
Published online: October 28, 2013
Processing time: 147 Days and 15.6 Hours
Abstract

AIM: To investigate the risk factors and characteristics of hepatocellular carcinoma (HCC) in the patients with drug-resistant chronic hepatitis B (CHB).

METHODS: A total of 432 patients with drug-resistant CHB were analyzed retrospectively from January 2004 to December 2012. The patients were divided into two groups: the HCC group (n = 57) and the non-HCC group (n = 375). Two groups compared using logistic regression for various patients and viral characteristics in order to identify associated risk factors for HCC. Secondarily, patient and tumor characteristics of HCC patients with naïve CHB (N group, n = 117) were compared to the HCC group (R group, n = 57) to identify any difference in HCC characteristics between them.

RESULTS: A significant difference was found for age, platelet count, alpha-fetoprotein (AFP), positivity of HBeAg, seroconversion rate of HBeAg, virologic response, the Child-Pugh score, presence of rtM204I, and the duration of antiviral treatment in non-HCC and HCC group. Cirrhosis, age (> 50 years), HBeAg (+), virologic non-responder status, and rtM204I mutants were independent risk factors for the development of HCC. The R group had lower serum C-reactive protein (CRP) and AFP levels, earlier stage tumors, and a shorter mean tumor surveillance period than the N group. However, the total follow-up duration was not significantly different between the two groups.

CONCLUSION: 13.2% of patients with drug-resistant CHB developed HCC. Age, cirrhosis, YIDD status, HBeAg status, and virologic response are associated with risk of HCC. Patients with drug-resistant CHB and these clinical factors may benefit from closer HCC surveillance.

Keywords: Carcinoma; Hepatocellular; Hepatitis B; Drug resistance; Risk factors; Characteristics

Core tip: There are few studies on hepatocarcinogenesis in patients with drug-resistant chronic hepatitis B (CHB) or on the characteristics of tumors arising from drug-resistant CHB. In the present study, the cumulative incidence rate of hepatocellular carcinoma (HCC) in patients with drug-resistant CHB was 4.6%, 6.9%, 8.87%, and 11.8% at the end of 1, 2, 3, and 5 years, respectively. Additionally, cirrhosis, age > 50 years, HBeAg (+), YIDD mutations, and a virologic non-responder status were independent risk factors for the development of HCC in CHB patients with drug resistance. Furthermore, there was a trend of poorer survival in patients with HCC arising from resistant CHB than in patients with HCC arising from naive CHB.