Rapid Alanine Aminotransferase Normalization with Entecavir and Hepatocellular Carcinoma in Hepatitis B Virus-Associated Cirrhosis

Eui Joo Kim, Jong Eun Yeon, Oh Sang Kwon, Heon Nam Lee, Seung Kak Shin, Seong Hee Kang, Kwan Soo Byun, Jeong Han Kim, So Young Kwon, Sang Jun Suh, Hyung Joon Yim, Yun Soo Kim, Ju Hyun Kim

Research output: Contribution to journalArticle

Abstract

Background: Sustained abnormal serum alanine aminotransferase (ALT) levels can increase the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. Aim: This study is aimed to confirm the impact of rapid ALT normalization (≤30 IU/L) on HCC risk in patients with hepatitis B virus (HBV)-associated cirrhosis after entecavir (ETV) commencement. Methods: A total of 578 treatment-naïve patients with HBV-associated cirrhosis (mean age 51 ± 9 years, male sex 63.3%) were treated with ETV for more than 1 year. Serum ALT and HBV DNA levels were measured at three time points (baseline, 6, and 12 months after ETV commencement) and subjected to risk factor analysis. Results: Median follow-up after ETV commencement was 43 (12–98) months. Cumulative incidences of HCC at 1, 3, 5, and 7 years were 0.3, 8.5, 19.5, and 30.6%, respectively. Univariate Cox regression analysis showed that older age, abnormal ALT at 6 months or 12 months, and lower platelet count were significant risk factors for HCC. However, gender, HBeAg positivity, abnormal ALT levels or HBV DNA levels at baseline, and detectable HBV DNA at 6 or 12 months were not risk factors. Multivariate analysis showed that older age (P < 0.001), abnormal ALT at 12 months (P = 0.006), and lower platelet count (P = 0.034) were the risk factors for HCC. Conclusions: Abnormal serum ALT levels after ETV commencement are significant risk factor for HCC. Therefore, ALT should be rapidly normalized to minimize the risk of HCC development in patients with HBV-associated cirrhosis.

Original languageEnglish
Pages (from-to)808-816
Number of pages9
JournalDigestive Diseases and Sciences
Volume62
Issue number3
DOIs
Publication statusPublished - 2017 Mar 1

Fingerprint

Alanine Transaminase
Hepatitis B virus
Hepatocellular Carcinoma
Fibrosis
Platelet Count
DNA
Serum
Hepatitis B e Antigens
entecavir
Chronic Hepatitis B
Statistical Factor Analysis
Multivariate Analysis
Regression Analysis
Incidence

Keywords

  • Alanine aminotransferase
  • Cirrhosis
  • Entecavir
  • Hepatitis B virus
  • Hepatocellular carcinoma

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Rapid Alanine Aminotransferase Normalization with Entecavir and Hepatocellular Carcinoma in Hepatitis B Virus-Associated Cirrhosis. / Kim, Eui Joo; Yeon, Jong Eun; Kwon, Oh Sang; Lee, Heon Nam; Shin, Seung Kak; Kang, Seong Hee; Byun, Kwan Soo; Kim, Jeong Han; Kwon, So Young; Suh, Sang Jun; Yim, Hyung Joon; Kim, Yun Soo; Kim, Ju Hyun.

In: Digestive Diseases and Sciences, Vol. 62, No. 3, 01.03.2017, p. 808-816.

Research output: Contribution to journalArticle

Kim, Eui Joo ; Yeon, Jong Eun ; Kwon, Oh Sang ; Lee, Heon Nam ; Shin, Seung Kak ; Kang, Seong Hee ; Byun, Kwan Soo ; Kim, Jeong Han ; Kwon, So Young ; Suh, Sang Jun ; Yim, Hyung Joon ; Kim, Yun Soo ; Kim, Ju Hyun. / Rapid Alanine Aminotransferase Normalization with Entecavir and Hepatocellular Carcinoma in Hepatitis B Virus-Associated Cirrhosis. In: Digestive Diseases and Sciences. 2017 ; Vol. 62, No. 3. pp. 808-816.
@article{3d13738380fd4a4f8e0d2e6f6649ed24,
title = "Rapid Alanine Aminotransferase Normalization with Entecavir and Hepatocellular Carcinoma in Hepatitis B Virus-Associated Cirrhosis",
abstract = "Background: Sustained abnormal serum alanine aminotransferase (ALT) levels can increase the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. Aim: This study is aimed to confirm the impact of rapid ALT normalization (≤30 IU/L) on HCC risk in patients with hepatitis B virus (HBV)-associated cirrhosis after entecavir (ETV) commencement. Methods: A total of 578 treatment-na{\"i}ve patients with HBV-associated cirrhosis (mean age 51 ± 9 years, male sex 63.3{\%}) were treated with ETV for more than 1 year. Serum ALT and HBV DNA levels were measured at three time points (baseline, 6, and 12 months after ETV commencement) and subjected to risk factor analysis. Results: Median follow-up after ETV commencement was 43 (12–98) months. Cumulative incidences of HCC at 1, 3, 5, and 7 years were 0.3, 8.5, 19.5, and 30.6{\%}, respectively. Univariate Cox regression analysis showed that older age, abnormal ALT at 6 months or 12 months, and lower platelet count were significant risk factors for HCC. However, gender, HBeAg positivity, abnormal ALT levels or HBV DNA levels at baseline, and detectable HBV DNA at 6 or 12 months were not risk factors. Multivariate analysis showed that older age (P < 0.001), abnormal ALT at 12 months (P = 0.006), and lower platelet count (P = 0.034) were the risk factors for HCC. Conclusions: Abnormal serum ALT levels after ETV commencement are significant risk factor for HCC. Therefore, ALT should be rapidly normalized to minimize the risk of HCC development in patients with HBV-associated cirrhosis.",
keywords = "Alanine aminotransferase, Cirrhosis, Entecavir, Hepatitis B virus, Hepatocellular carcinoma",
author = "Kim, {Eui Joo} and Yeon, {Jong Eun} and Kwon, {Oh Sang} and Lee, {Heon Nam} and Shin, {Seung Kak} and Kang, {Seong Hee} and Byun, {Kwan Soo} and Kim, {Jeong Han} and Kwon, {So Young} and Suh, {Sang Jun} and Yim, {Hyung Joon} and Kim, {Yun Soo} and Kim, {Ju Hyun}",
year = "2017",
month = "3",
day = "1",
doi = "10.1007/s10620-016-4431-8",
language = "English",
volume = "62",
pages = "808--816",
journal = "American Journal of Digestive Diseases",
issn = "0002-9211",
publisher = "Springer New York",
number = "3",

}

TY - JOUR

T1 - Rapid Alanine Aminotransferase Normalization with Entecavir and Hepatocellular Carcinoma in Hepatitis B Virus-Associated Cirrhosis

AU - Kim, Eui Joo

AU - Yeon, Jong Eun

AU - Kwon, Oh Sang

AU - Lee, Heon Nam

AU - Shin, Seung Kak

AU - Kang, Seong Hee

AU - Byun, Kwan Soo

AU - Kim, Jeong Han

AU - Kwon, So Young

AU - Suh, Sang Jun

AU - Yim, Hyung Joon

AU - Kim, Yun Soo

AU - Kim, Ju Hyun

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background: Sustained abnormal serum alanine aminotransferase (ALT) levels can increase the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. Aim: This study is aimed to confirm the impact of rapid ALT normalization (≤30 IU/L) on HCC risk in patients with hepatitis B virus (HBV)-associated cirrhosis after entecavir (ETV) commencement. Methods: A total of 578 treatment-naïve patients with HBV-associated cirrhosis (mean age 51 ± 9 years, male sex 63.3%) were treated with ETV for more than 1 year. Serum ALT and HBV DNA levels were measured at three time points (baseline, 6, and 12 months after ETV commencement) and subjected to risk factor analysis. Results: Median follow-up after ETV commencement was 43 (12–98) months. Cumulative incidences of HCC at 1, 3, 5, and 7 years were 0.3, 8.5, 19.5, and 30.6%, respectively. Univariate Cox regression analysis showed that older age, abnormal ALT at 6 months or 12 months, and lower platelet count were significant risk factors for HCC. However, gender, HBeAg positivity, abnormal ALT levels or HBV DNA levels at baseline, and detectable HBV DNA at 6 or 12 months were not risk factors. Multivariate analysis showed that older age (P < 0.001), abnormal ALT at 12 months (P = 0.006), and lower platelet count (P = 0.034) were the risk factors for HCC. Conclusions: Abnormal serum ALT levels after ETV commencement are significant risk factor for HCC. Therefore, ALT should be rapidly normalized to minimize the risk of HCC development in patients with HBV-associated cirrhosis.

AB - Background: Sustained abnormal serum alanine aminotransferase (ALT) levels can increase the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. Aim: This study is aimed to confirm the impact of rapid ALT normalization (≤30 IU/L) on HCC risk in patients with hepatitis B virus (HBV)-associated cirrhosis after entecavir (ETV) commencement. Methods: A total of 578 treatment-naïve patients with HBV-associated cirrhosis (mean age 51 ± 9 years, male sex 63.3%) were treated with ETV for more than 1 year. Serum ALT and HBV DNA levels were measured at three time points (baseline, 6, and 12 months after ETV commencement) and subjected to risk factor analysis. Results: Median follow-up after ETV commencement was 43 (12–98) months. Cumulative incidences of HCC at 1, 3, 5, and 7 years were 0.3, 8.5, 19.5, and 30.6%, respectively. Univariate Cox regression analysis showed that older age, abnormal ALT at 6 months or 12 months, and lower platelet count were significant risk factors for HCC. However, gender, HBeAg positivity, abnormal ALT levels or HBV DNA levels at baseline, and detectable HBV DNA at 6 or 12 months were not risk factors. Multivariate analysis showed that older age (P < 0.001), abnormal ALT at 12 months (P = 0.006), and lower platelet count (P = 0.034) were the risk factors for HCC. Conclusions: Abnormal serum ALT levels after ETV commencement are significant risk factor for HCC. Therefore, ALT should be rapidly normalized to minimize the risk of HCC development in patients with HBV-associated cirrhosis.

KW - Alanine aminotransferase

KW - Cirrhosis

KW - Entecavir

KW - Hepatitis B virus

KW - Hepatocellular carcinoma

UR - http://www.scopus.com/inward/record.url?scp=85007460049&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85007460049&partnerID=8YFLogxK

U2 - 10.1007/s10620-016-4431-8

DO - 10.1007/s10620-016-4431-8

M3 - Article

C2 - 28035553

AN - SCOPUS:85007460049

VL - 62

SP - 808

EP - 816

JO - American Journal of Digestive Diseases

JF - American Journal of Digestive Diseases

SN - 0002-9211

IS - 3

ER -