Development of hepatocellular carcinoma after seroclearance of hepatitis B surface antigen.
OBJECTIVE
During the natural course of chronic hepatitis B virus infection, a small proportion of patients experience hepatitis B surface antigen (HBsAg) seroclearance. However, the long-term clinical outcomes of this process are not well established.


METHODS
Thirty-five patients with chronic hepatitis B, followed between 1976 and 2008 at a community liver clinic, experienced HBsAg seroclearance. Ten patients were Caucasian and 25 were Asian. These patients continued to undergo surveillance for hepatocellular carcinoma that included test for alpha-fetoprotein levels and abdominal ultrasound examinations. The median follow-up time was 185 months (range, 27-400 months).


RESULTS
During the initial visit to the clinic, the median age of the patients was 41 years (range, 1.5-72 years). Eighteen patients (51.4%) were hepatitis B e antigen (HBeAg) positive 25 (71.4%) were hepatitis B virus DNA positive, and 13 (37.1%) had cirrhosis. At the time of HBsAg loss, the median age was 54 years (range, 13-77 years) and all were hepatitis B e antigen- as well as hepatitis B virus DNA negative. During the long-term follow-up, 4 patients with cirrhosis developed hepatocellular carcinoma (HCC), which was discovered by ultrasound examination. Factors associated with development of HCC were low baseline levels of albumin (P = .04), family histories of HBsAg positivity (P = .01) and HCC (P = .04), and age of less than 50 years at the time of HBsAg clearance (P = .03).


CONCLUSIONS
HCC can still develop after HBsAg seroclearance. Thus, surveillance should be continued after HBsAg loss in the same manner as for HBsAg positive patients.
Tong
Myron John
MJ
The Pfleger Liver Institute and the Division of Digestive Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA. myrontong@hmri.org
Nguyen
Michael Ong
MO
Tong
Lori Terese
LT
Blatt
Lawrence Mitchell
LM
D000005:Abdomen / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000032:analysis
D006514:Hepatitis B Surface Antigens; D000509:alpha-Fetoproteins