Ploutarchos Pastras: Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece.
Evaggelos Zazas: Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece.
Maria Kalafateli: Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece.
Ioanna Aggeletopoulou: Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece. ORCID
Efthymios P Tsounis: Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece. ORCID
Stavros Kanaloupitis: Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece.
Konstantinos Zisimopoulos: Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece. ORCID
Eirini-Eleni-Konstantina Kottaridou: Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece.
Aspasia Antonopoulou: Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece.
Dimosthenis Drakopoulos: Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece.
Georgia Diamantopoulou: Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece.
Aggeliki Tsintoni: Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece. ORCID
Konstantinos Thomopoulos: Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece.
Christos Triantos: Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece. ORCID
Chronic hepatitis B (CHB) infection constitutes a leading cause of hepatocellular carcinoma (HCC) development. The identification of HCC risk factors and the development of prognostic risk scores are essential for early diagnosis and prognosis. The aim of this observational, retrospective study was to evaluate baseline risk factors associated with HCC in CHB. Six hundred thirty-two consecutive adults with CHB ( = 632) [median age: 46 (IQR: 24)], attending the outpatients' Hepatology clinics between 01/1993-09/2020 were evaluated. Core promoter mutations and cirrhosis-HCC (GAG-HCC), Chinese University-HCC (CU-HCC), risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B), Fibrosis-4 (FIB-4), and Platelet Age Gender-HBV (PAGE-B) prognostic scores were calculated, and receiver operating curves were used to assess their prognostic performance. HCC was developed in 34 (5.38%) patients. In the multivariable Cox regression analysis, advanced age (HR: 1.086, 95% CI: 1.037-1.137), male sex (HR: 7.696, 95% CI: 1.971-30.046), alcohol abuse (HR: 2.903, 95% CI: 1.222-6.987) and cirrhosis (HR: 21.239, 95% CI: 6.001-75.167) at baseline were independently associated with the development of HCC. GAG-HCC and PAGE-B showed the highest performance with c-statistics of 0.895 (95% CI: 0.829-0.961) and 0.857 (95% CI: 0.791-0.924), respectively. In the subgroup of patients with cirrhosis, the performance of all scores declined. When treated and untreated patients were studied separately, the discriminatory ability of the scores differed. In conclusion, HCC development was independently associated with advanced age, male sex, alcohol abuse, and baseline cirrhosis among a diverse population with CHB. GAG-HCC and PAGE-B showed high discriminatory performance to assess the risk of HCC development in these patients, but these performances declined in the subgroup of patients with cirrhosis. Further research to develop scores more specific to certain CHB subgroups is needed.
