Current trendHepatitis B: Liver fibrosis and hepatocellular carcinomaHépatite B : fibrose hépatique et carcinome hépatocellulaire
Introduction
Chronic hepatitis B virus (HBV) infection is estimated to be the cause of 55–60% of hepatocellular carcinoma (HCC) in the world. The annual incidence of HCC has been estimated to be less than 1% for non-cirrhotic carriers and 2%–3% for patients with cirrhosis [1]. Several lines of evidence indicate that the incidence of HCC is higher among Asians than Caucasians. This difference may be partly related to a longer duration of infection among Asians (perinatal vs. adult acquired infection) but several studies suggest that other factors such as HBV genotype and exposure to aflatoxin may contribute to this difference. This article will review:
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the frequency in which HBV-related HCC is found in the absence of cirrhosis;
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the utility of non-invasive tests for assessment of hepatic fibrosis or cirrhosis;
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the risk factors for HCC in persons with chronic HBV infection.
Section snippets
HBV-related HCC in patients without significant fibrosis or cirrhosis
Cirrhosis, regardless of etiology, is considered to be the most important risk factor for HCC. It has been estimated that up to 40% of HBV-related HCC occur in persons who do not have cirrhosis while almost all cases of hepatitis C virus (HCV)-related HCC occur in the setting of cirrhosis. The explanation for the more frequent occurrence of HBV-related HCC in the absence of cirrhosis has been attributed to the direct oncogenic effects of HBV. It should be emphasized that the proportion of HCC
Non-invasive tests for hepatic fibrosis or cirrhosis
Liver biopsy is the gold standard for assessment of hepatic fibrosis or cirrhosis but it is an invasive procedure with a risk of significant bleeding of one in 2500 to one in 10,000 and a risk of death of less than or equal to one in 10,000 and is subject to sampling error [8]. During the last 15 years, there has been extensive research into non-invasive tests for hepatic fibrosis or cirrhosis. These tests include indices or algorithms based on routine laboratory tests, panels of serum fibrosis
Risk factors for HBV-related HCC
Until recently, older age, male gender and cirrhosis were the major risk factors associated with HCC development. Recent studies showed that HBV replication status, HBV genotype and mutations in the basal core promoter region play an important role in HCC development. These data indicate that algorithms incorporating demographics, viral factors, degree of necroinflammation and extent of fibrosis may be more accurate in predicting the risk of HBV-related HCC than fibrosis staging alone [22].
Conclusion
Most cases of HBV-related HCC occur in the setting of cirrhosis but HBV-related HCC can occur in non-cirrhotic livers. Besides cirrhosis, host and viral factors contribute to the risk of HCC. Data on non-invasive assessment of liver fibrosis in persons with chronic HBV infection are limited. Available data suggest that biomarkers and serum panels of routine laboratory tests / fibrosis makers have similar accuracies in predicting advanced fibrosis or cirrhosis in persons with HBV infection as
Conflicts of interest
None.
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