title: Risk stratification of hepatocellular carcinoma in hepatitis B virus e antigen-negative carriers by combining viral biomarkers.
abstract: BACKGROUND
  The serum hepatitis B virus (HBV) surface antigen (HBsAg) level can predict hepatocellular carcinoma (HCC) development in hepatitis B e antigen (HBeAg)-negative patients with an HBV DNA level of <2000 IU/mL. However, little is known regarding how well the combination of both viral biomarkers stratifies HCC risk.
  
  
  METHODS
  A total of 2165 Taiwanese HBeAg-negative noncirrhotic patients were followed for 14.9 years. The predictive power of the HBsAg level for HCC was analyzed for different viral load ranges.
  
  
  RESULTS
  In patients with HBV DNA levels of 2000-19 999 IU/mL (intermediate viral load), a positive correlation between HBsAg level and HCC development was identified after adjustment for other risk factors (P = .002). In contrast, no association was found between HBsAg level and HCC in patients with higher viral loads. HBsAg level was subsequently included to stratify HCC risk in patients with low and intermediate viral loads. Receiver operating characteristic curve analysis showed that combining HBV DNA and HBsAg level better predicts 10-year HCC development as compared to using HBV DNA level alone in the overall cohort (P = .028).
  
  
  CONCLUSIONS
  Serum HBsAg level helps stratify HCC risk in patients with intermediate viral loads. Combining HBV DNA and HBsAg levels better predicts HCC risk.
authors: Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital Taipei Branch, New Taipei, Taiwan.
authors: Tai-Chung
authors: TC
authors: Tseng
authors: Chun-Jen
authors: CJ
authors: Liu
authors: Chi-Ling
authors: CL
authors: Chen
authors: Hung-Chih
authors: HC
authors: Yang
authors: Tung-Hung
authors: TH
authors: Su
authors: Chia-Chi
authors: CC
authors: Wang
authors: Wan-Ting
authors: WT
authors: Yang
authors: Stephanie Fang-Tzu
authors: SF
authors: Kuo
authors: Chen-Hua
authors: CH
authors: Liu
authors: Pei-Jer
authors: PJ
authors: Chen
authors: Ding-Shinn
authors: DS
authors: Chen
authors: Jia-Horng
authors: JH
authors: Kao
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D002353:Carrier State; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006513:Hepatitis B e Antigens / Q000097:blood*; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology; D019562:Viral Load
chemical_list: D015415:Biomarkers; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens
keywords: HBV DNA; HBsAg; HCC; intermediate viral load; minimal risk; viral hepatitis