Journal of Hepatocellular Carcinoma (Oct 2022)

Incidence of Hepatocellular Carcinoma and Decompensated Liver Cirrhosis and Prognostic Accuracy of the PAGE-B HCC Risk Score in a Low Endemic Hepatitis B Virus Infected Population

  • Bollerup S,
  • Engsig F,
  • Hallager S,
  • Mocroft A,
  • Roege BT,
  • Christensen PB,
  • Laursen AL,
  • Krarup H,
  • Clausen MR,
  • Thielsen P,
  • Madsen LG,
  • Noerregaard L,
  • Barfod TS,
  • Balslev U,
  • Tarp B,
  • Hansen JB,
  • Mygind LH,
  • Gerstoft J,
  • Weis N

Journal volume & issue
Vol. Volume 9
pp. 1093 – 1104

Abstract

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Signe Bollerup,1 Frederik Engsig,1 Sofie Hallager,1 Amanda Mocroft,2,3 Birgit T Roege,4 Peer B Christensen,5,6 Alex L Laursen,7 Henrik Krarup,8,9 Mette R Clausen,10 Peter Thielsen,11 Lone G Madsen,12,13 Lars Noerregaard,14 Toke S Barfod,15 Ulla Balslev,16 Britta Tarp,17 Jesper B Hansen,9 Lone H Mygind,18 Jan Gerstoft,13,19 Nina Weis1,13 1Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; 2Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, England; 3Centre of Excellence for Health, Immunity and Infections (CHIP) and PERSIMUNE, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 4Department of Internal Medicine, Kolding Hospital, Kolding, Denmark; 5Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; 6Clinical Institute, University of Southern Denmark, Odense, Denmark; 7Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; 8Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark; 9Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark; 10Department of Medical Gastroenterology and Hepatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 11Department of Gastroenterology, Herlev Hospital, Herlev, Denmark; 12Department of Medical Gastroenterology, Zealand University Hospital, Koege, Denmark; 13Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 14Department of Lung- and Infectious Diseases, North Zealand Hospital, Hilleroed, Denmark; 15Department of Internal Medicine and Infectious Diseases, Zealand University Hospital, Roskilde, Denmark; 16Department of Infectious Diseases, Herlev Hospital, Herlev, Denmark; 17Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark; 18Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; 19Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkCorrespondence: Nina Weis, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark, Tel: +45 38623514, Email [email protected]: We aimed to determine incidence of hepatocellular carcinoma (HCC) and decompensated liver cirrhosis in persons with chronic hepatitis B virus (HBV) infection in Denmark stratified by disease phase, liver cirrhosis, and treatment status at baseline. Additionally, we aimed to assess the prognostic value of the PAGE-B HCC risk score in a mainly non-cirrhotic population.Patients and Methods: In this register-based cohort study, we included all individuals over the age of 18, with chronic HBV infection first registered between 2002 and 2016 in at least one of three nationwide registers. The study population was followed until HCC, decompensated liver cirrhosis, death, emigration, or December 31, 2017, which ever came first.Results: Among 6016 individuals included in the study, 10 individuals with and 23 without baseline liver cirrhosis developed HCC during a median follow up of 7.3 years (range 0.0– 15.5). This corresponded to five-year cumulative incidences of 7.1% (95% confidence interval (CI) 2.0– 12.3) and 0.2% (95% CI 0.1– 0.4) in persons with and without baseline liver cirrhosis. The five-year cumulative incidence of decompensated liver cirrhosis was 0.7% (95% CI 0.5– 1.0). Among 2038 evaluated for liver events stratified by disease phase, incidence of HCC was low in all who were non-cirrhotic and untreated for HBV at baseline. PAGE-B score was evaluated in 1529 persons. The 5-year cumulative incidence of HCC was 0, 0.8 (95% CI 0.5– 1.8), and 8.7 (95% CI 1.0– 16.4) in persons scoring 17, respectively (c-statistic 0.91 (95% CI 0.84– 0.98)).Conclusion: We found low incidence of HCC and decompensated liver cirrhosis in persons with chronic HBV infection in Denmark. Moreover, the PAGE-B score showed good accuracy for five-year risk of developing HCC in the population with chronic HBV infection in Denmark.Keywords: hepatitis B virus, viral hepatitis, Scandinavia, morbidity, nationwide

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