Spontaneous HBsAg clearance vs. HBsAg clearance induced by antiviral therapy: there is a difference in the risk of liver cancer between the two | Research Express

Author: Cai Hao East chief physician Beijing Ditan Hospital, the medical article is the author's permission Naomaitong release, please do not reprint without authorization.

There are two ways to clear hepatitis B surface antigen (HBsAg) in chronic hepatitis B virus (HBV) infected persons: one is spontaneous HBsAg clearance, and HBV infected persons after hepatitis B e antigen (HBeAg) seroconversion Spontaneous HBsAg clearance occurs in about 0.
5% to 1.
0% every year [1]; the second is HBsAg clearance induced by antiviral therapy.
In recent years, with the widespread use of antiviral drugs, patients with HBsAg clearance have gradually increased.

Studies have shown that 10 years after the disappearance of HBsAg, cccDNA can still be detected in the liver of about 14% of patients.

Therefore, although the probability of developing hepatocellular carcinoma after the disappearance of HBsAg is significantly reduced, it may still occur.

So, is the incidence of hepatocellular carcinoma after spontaneous HBsAg clearance and antiviral therapy-induced HBsAg clearance the same? Recently, a study by Park et al.
[2] in South Korea gave the answer.

Research introduction Park et al.
reviewed 1,200 adult HBV-infected patients who were cleared of HBsAg.
The median age was 56 years old.
There were 824 males (68.
7%), 165 cirrhosis patients (13.
8%), and 984 spontaneous HBsAg cleared patients (82.
0%).
) And antiviral therapy induced HBsAg clearance in 216 cases (18.
0%).

The results of the study were followed up for an average of 4.
8 years (0.
5 to 17.
8 years), and 23 cases (1.
9%) developed liver cancer.

The incidence of hepatocellular carcinoma in HBsAg cleared patients induced by antiviral therapy was significantly higher than that in spontaneous HBsAg cleared patients (3.
9% and 0.
9% at 5 years, respectively). The 5-year incidence of hepatocellular carcinoma in the spontaneous removal group without cirrhosis, the antiviral induction removal group without cirrhosis, the spontaneous removal group with cirrhosis, and the antiviral induction removal group with cirrhosis were 0.
5%, 1.
2%, and 4.
0, respectively % And 10.
5% (Figure 1).

Figure 1 The cumulative incidence of hepatocellular carcinoma in different HBsAg scavengers.
Discussion The reason why the incidence of hepatocellular carcinoma in HBsAg scavengers induced by antiviral therapy is higher than that of spontaneous HBsAg scavengers is clear in the discussion.

Antiviral drugs are usually used in patients with chronic hepatitis B with persistent liver inflammation.
These patients have a significantly higher degree of liver inflammation before HBsAg clearance compared with spontaneous HBsAg clearance, and the time is significantly longer; just from the baseline of the study.
It can be seen that the proportion of liver cirrhosis in spontaneous HBsAg scavengers is 10.
9% (107/984), and the proportion of cirrhosis in HBsAg scavengers induced by antiviral therapy is 26.
9% (58/216), which is significantly higher than that of spontaneous HBsAg scavengers.
HBsAg cleared (P<0.
001).

The spontaneous HBsAg clearance is achieved through the body's immune mechanism, indicating that the body may have a strong immune control effect on HBV.

This study by Park et al.
tells us that patients who achieve HBsAg clearance after antiviral therapy should still be alert to the occurrence of hepatocellular carcinoma, especially those with liver cirrhosis or severe liver disease. References: [1] Chinese Medical Association Hepatology Branch, Chinese Medical Association Infectious Diseases Branch.
Guidelines for Prevention and Treatment of Chronic Hepatitis B (2015 Edition) [J].
Chinese Journal of Hepatology (Electronic Edition).
2015.
(3): 1-18.
[2]Park Y, Lee JH, Sinn DH, et al.
Risk and Risk Score Performance of Hepatocellular Carcinoma Development in Patients With Hepatitis B Surface Antigen Seroclearance[J].
Clin Transl Gastroenterol.
2021.
12(1) : e00290.