Risk of Liver Cancer Lurking Even After Complete Cure of Hepatitis B: "Predictable by Risk Factors"

Seoul St. Mary's Hospital Jang Jeongwon and Eunpyeong St. Mary's Hospital Yang Hyun Research Team
Longest 30-Year Follow-Up of 1,400 Chronic Hepatitis B Cure Patients
Risk Factors Identified Including Elderly, Cirrhosis, Alcohol Use, and Family History of Liver Cancer
World's First Liver Cancer Risk Prediction Model Developed After Hepatitis B Cure

Jang Jeong-won (left) from Seoul St. Mary's Hospital, Professor Yang Hyun from Eunpyeong St. Mary's Hospital.

[Asia Economy Reporter Lee Gwan-joo] Domestic researchers have developed a model to predict the likelihood of liver cancer even after complete cure of hepatitis B. Although the prevalence of hepatitis B is decreasing compared to the past, it is still considered the most important cause of liver cancer. If this can be anticipated in advance, it is expected that management can be carried out to prevent hepatitis B patients from progressing to liver cancer.

According to the medical community on the 17th, Professor Jang Jung-won of the Department of Gastroenterology at Seoul St. Mary’s Hospital, The Catholic University of Korea, and Professor Yang Hyun of Eunpyeong St. Mary’s Hospital have developed the world’s first risk prediction model for liver cancer occurrence in patients who have lost hepatitis B surface antigen, and reported it to the academic community through the September issue of the internationally renowned journal in hepatology, the Journal of Hepatology.

Hepatitis B is the most important risk factor for liver cancer occurrence in Korea, accounting for 60-70% of all liver cancer cases. In particular, about 2.5-3% of the population in Korea are carriers of the hepatitis B virus, showing a high prevalence. About 20% of chronic carriers who have been persistently infected with the hepatitis B virus for more than six months progress to liver cirrhosis, and among patients with liver cirrhosis, about 2-7% develop liver cancer annually. Additionally, hepatitis B virus carriers are known to have a risk of liver cancer occurrence about 100 times higher than normal individuals. The so-called "functional cure" of hepatitis B, where the hepatitis B surface antigen disappears, shows a favorable prognosis, but some patients can still develop liver cancer.

The research team tracked and observed a total of 1,443 chronic patients who lost hepatitis B surface antigen at hospitals under the Catholic Central Medical Center for up to 30 years. Through this, they identified that ▲age at the time of hepatitis B surface antigen loss ▲presence of liver cirrhosis ▲alcohol consumption exceeding moderate levels (more than 2 drinks per day for men, more than 1 drink per day for women) ▲family history of hepatocellular carcinoma are risk factors for liver cancer occurrence even after hepatitis B surface antigen loss.

Prediction Model for Hepatocellular Carcinoma Occurrence After Hepatitis B Surface Antigen Loss.

Using these four risk factors, they developed a risk prediction model for hepatocellular carcinoma occurrence. The 5-year, 10-year, and 15-year predictive performances evaluated by time-dependent ROC (Receiver Operating Characteristic) curves were 0.799, 0.835, and 0.817 respectively, confirming excellent performance. Generally, a ROC curve area above 0.8 is considered an excellent predictive model. The model was also validated internally to confirm prediction accuracy.

Professor Yang said, “This study is significant in revealing that liver cancer can occur even after hepatitis B is cured and identifying which patients need more focused and meticulous follow-up.” He emphasized, “It is important not to miss liver cancer surveillance tests, especially for patients who already have liver cirrhosis or a family history of liver cancer after hepatitis B cure, those who consume large amounts of alcohol, or elderly patients.”

Professor Jang said, “The model developed through this study is the world’s first predictive model for liver cancer risk after hepatitis B cure,” adding, “This model, which uses easily obtainable patient health information through regular examinations, is expected to contribute to the development of guidelines for appropriate clinical management of patients cured of hepatitis B in the future.”

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