Effect of potent nucleos(t)ide analog on alpha fetoprotein changes and occurrence of hepatocellular carcinoma in patients with chronic hepatitis B.

IF 2.8 2区医学 Q3 IMMUNOLOGY Infectious Agents and Cancer Pub Date : 2025-02-07 DOI:10.1186/s13027-025-00639-1

Qianqian Ma, Junzhao Ye, Ling Luo, Yanhong Sun, Wei Wang, Shiting Feng, Bing Liao, Bihui Zhong

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Abstract

Background: Successful antiviral therapy significantly decreases the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). Alpha-fetoprotein (AFP) in the serum is a valuable early indicator of HCC. However, it is unclear whether different antiviral medications have varying effects on AFP levels. The purpose of this study was to evaluate this issue in those treated with entecavir (ETV) versus tenofovir disoproxil fumarate (TDF).

Methods: We prospectively enrolled treatment-naive CHB adults who commenced treatment with ETV or TDF. Their changes in biochemical, virological, and fibrosis parameters and the elevation of AFP or development of HCC during follow-up were analyzed.

Results: A total of 1942 CHB patients were included (10-90% follow-up time 3-60 months), and 104 patients with elevated AFP (5.3%) and 27 patients with HCC development (1.4%) were identified during the follow-up. The difference in the cumulative incidence of AFP abnormalities and HCC was statistically significant between patients who received ETV or TDF therapy. Multivariate Cox regression showed that elevated liver stiffness with shear wave elastography (Hazard ratio (HR) = 1.05, 95% Confidence interval (CI) 1.03-1.08, P < 0.001) and abnormal AFP at baseline (HR = 1.00, 95% CI 1.00-1.00, P < 0.001) were independent risk factors for abnormal AFP in CHB patients, while shear wave elastography (HR = 1.07, 95% CI 1.02-1.12, P < 0.001) was also independent risk factor for HCC. Similar results were obtained after propensity score matching (PSM) analysis. The combination of shear wave elastography (SWE), mPage-B score, age and type 2 diabetes mellitus had an area under the curve of 0.838 (P < 0.001) in predicting the occurrence of HCC.

Conclusions: Similar AFP elevation and HCC development rates were observed in CHB patients treated with ETV or TDF. Elevated SWE and abnormal AFP at baseline were independent risk factors for abnormal AFP in CHB patients.

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强效核苷类似物对慢性乙型肝炎患者甲胎蛋白变化和肝癌发生的影响

背景：成功的抗病毒治疗可显著降低慢性乙型肝炎（CHB）患者肝细胞癌（HCC）的发生率。血清中甲胎蛋白（AFP）是HCC的一个有价值的早期指标。然而，尚不清楚不同的抗病毒药物是否对AFP水平有不同的影响。本研究的目的是评估恩替卡韦（ETV）与富马酸替诺福韦（TDF）治疗的患者的这一问题。方法：我们前瞻性地招募了接受ETV或TDF治疗的初治慢性乙型肝炎成人。分析随访期间两组患者的生化、病毒学、纤维化指标变化及AFP升高或HCC发生情况。结果：共纳入CHB患者1942例（随访时间为10-90%，随访时间为3-60个月），随访期间发现AFP升高患者104例（5.3%），HCC发展患者27例（1.4%）。在接受ETV或TDF治疗的患者中，AFP异常和HCC的累积发生率差异有统计学意义。多因素Cox回归显示剪切波弹性成像显示肝硬度升高(风险比（HR) = 1.05, 95%可信区间（CI） 1.03-1.08， P）结论：在接受ETV或TDF治疗的CHB患者中观察到相似的AFP升高和HCC发展率。基线时SWE升高和AFP异常是CHB患者AFP异常的独立危险因素。

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来源期刊

Infectious Agents and Cancer ONCOLOGY-IMMUNOLOGY

CiteScore

5.80

自引率

2.70%

发文量

期刊介绍： Infectious Agents and Cancer is an open access, peer-reviewed online journal that encompasses all aspects of basic, clinical, epidemiological and translational research providing an insight into the association between chronic infections and cancer. The journal welcomes submissions in the pathogen-related cancer areas and other related topics, in particular: • HPV and anogenital cancers, as well as head and neck cancers; • EBV and Burkitt lymphoma; • HCV/HBV and hepatocellular carcinoma as well as lymphoproliferative diseases; • HHV8 and Kaposi sarcoma; • HTLV and leukemia; • Cancers in Low- and Middle-income countries. The link between infection and cancer has become well established over the past 50 years, and infection-associated cancer contribute up to 16% of cancers in developed countries and 33% in less developed countries. Preventive vaccines have been developed for only two cancer-causing viruses, highlighting both the opportunity to prevent infection-associated cancers by vaccination and the gaps that remain before vaccines can be developed for other cancer-causing agents. These gaps are due to incomplete understanding of the basic biology, natural history, epidemiology of many of the pathogens that cause cancer, the mechanisms they exploit to cause cancer, and how to interrupt progression to cancer in human populations. Early diagnosis or identification of lesions at high risk of progression represent the current most critical research area of the field supported by recent advances in genomics and proteomics technologies.