title: Rates of cirrhosis and hepatocellular carcinoma in chronic hepatitis B and the role of surveillance: a 10-year follow-up of 673 patients.
abstract: OBJECTIVE
  Development of cirrhosis and hepatocellular carcinoma (HCC) are critical milestones in the natural history of chronic hepatitis B virus (HBV) infection. There are no prospective data on the risk of these critical milestones in HBV patients in Singapore. The efficacy and justification of HCC surveillance is determined by the rate of HCC development. Our study aims to determine the rates of cirrhosis and HCC in HBV patients in Singapore and hence the appropriateness of HCC surveillance.
  
  
  METHODS
  A total of 673 HBV patients were enrolled between March 2003 and March 2004 and followed up for 10 years with regular surveillance for HCC using α-fetoprotein and abdominal ultrasound.
  
  
  RESULTS
  Overall, 62.6% of the patients were men, mean age 56.4 years. In all, 31% were hepatitis B e antigen-positive and 14.9% had cirrhosis at baseline. Seventy-four patients developed cirrhosis and 42 patients developed HCC after 10 years. The overall 10-year incidence of cirrhosis and HCC was 16.2% (1.6%/year) and 7.8% (0.8%/year), respectively. The overall incidence of HCC in cirrhotics was 29.7% (3.0%/year), highest within a year of diagnosis of cirrhosis (7.9%). The rate of cirrhosis was significantly higher in those aged more than 55 years (P=0.001). Sex and hepatitis B e antigen status did not affect the rate of cirrhosis. Factors with significantly higher overall rates of HCC were age 55 years or more (P=0.001), male sex (P=0.001), and baseline α-fetoprotein of 4.1 µg/l or more (P<0.0001). However, age more than 55 years was not significant in the development of HCC in cirrhotics.
  
  
  CONCLUSIONS
  The rate of cirrhosis in HBV patients in Singapore is about 1.6% per year. The rate of HCC is about 0.8% per year overall and 3.0% per year in cirrhotics, which justifies HCC surveillance.
authors.affiliation: aDepartment of Gastroenterology & Hepatology, Singapore General Hospital bDuke-NUS Graduate Medical School, Singapore.
authors.forename: Zhongxian
authors.initials: Z
authors.lastname: Poh
authors.forename: Boon-Bee George
authors.initials: BB
authors.lastname: Goh
authors.forename: Pik-Eu Jason
authors.initials: PE
authors.lastname: Chang
authors.forename: Chee-Kiat
authors.initials: CK
authors.lastname: Tan
mesh_terms: D000367:Age Factors; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000821:virology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012737:Sex Factors; D012846:Singapore / Q000453:epidemiology; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D006513:Hepatitis B e Antigens; D000509:alpha-Fetoproteins
references.citation: Eur J Gastroenterol Hepatol. 2000 Jun;12(6):687-93
references.pmid: 10912490
references.citation: Hepatology. 2011 Mar;53(3):1020-2
references.pmid: 21374666
references.citation: J Gastroenterol Hepatol. 2000 May;15 Suppl:E3-6
references.pmid: 10921373
references.citation: Gut. 2001 Feb;48(2):251-9
references.pmid: 11156649
references.citation: J Clin Gastroenterol. 2002 May-Jun;34(5):569-72
references.pmid: 11960072
references.citation: N Engl J Med. 2002 Jul 18;347(3):168-74
references.pmid: 12124405
references.citation: Gastroenterology. 2002 Dec;123(6):1848-56
references.pmid: 12454842
references.citation: J Hepatol. 2003;39 Suppl 1:S50-8
references.pmid: 14708678
references.citation: Gastroenterology. 2004 Nov;127(5 Suppl 1):S35-50
references.pmid: 15508101
references.citation: Cancer. 1988 May 15;61(10):1942-56
references.pmid: 2834034
references.citation: Hepatology. 1988 May-Jun;8(3):493-6
references.pmid: 3371868
references.citation: Liver. 1989 Aug;9(4):235-41
references.pmid: 2770436
references.citation: Arch Intern Med. 1990 May;150(5):1051-4
references.pmid: 2158773
references.citation: Gut. 1991 Mar;32(3):294-8
references.pmid: 2013423
references.citation: CMAJ. 1992 Feb 15;146(4):473-81
references.pmid: 1306034
references.citation: Am J Med. 1996 Oct;101(4):422-34
references.pmid: 8873514
references.citation: J Cancer Res Clin Oncol. 2004 Jul;130(7):417-22
references.pmid: 15042359
references.citation: J Hepatol. 2008 Feb;48(2):335-52
references.pmid: 18096267
references.citation: J Hepatol. 2009 Jan;50(1):80-8
references.pmid: 18977053
references.citation: Hepatology. 2010 Sep;52(3):886-93
references.pmid: 20683932
references.citation: J Viral Hepat. 2009 Jan;16(1):53-63
references.pmid: 19192158
references.citation: J Hepatol. 2012 Apr;56(4):908-43
references.pmid: 22424438
references.citation: Lancet. 2013 Feb 9;381(9865):468-75
references.pmid: 23234725
references.citation: Gastroenterology. 2013 May;144(5):933-44
references.pmid: 23415803
references.citation: Hepatology. 2013 Jul;58(1):98-107
references.pmid: 23213040