Long-Term Incidence of Hepatocellular Carcinoma After Hepatitis B Surface Antigen Seroclearance
Menée à partir de données portant sur 13 379 patients atteints d'une hépatite B chronique et ayant obtenu une clairance sérologique de l'antigène de surface du virus de l'hépatite B (durée médiane de suivi : 5,6 ans ; 59,8 % d'hommes ; âge moyen : 59,7 ans), cette étude analyse l'incidence du carcinome hépatocellulaire chez ces patients par rapport à la population générale
Background & Aims: The risk of hepatocellular carcinoma (HCC) decreases after hepatitis B surface antigen (HBsAg) seroclearance. We examined HCC incidence in patients with chronic hepatitis B (CHB) who cleared HBsAg compared with the general population.
Methods: All adults with CHB who cleared HBsAg between 2000 and 2022 were identified using a territory-wide database in Hong Kong. Annual HCC incidences were estimated and compared with the general population. Age- and sex-specific population statistics were retrieved from the Hong Kong Cancer Registry and Census and Statistics Department.
Results: Of 13,379 patients with HBsAg seroclearance (mean age, 59.7 ± 13.7 years; 59.8% men, 14.6% cirrhosis), HCC developed in 274 (2.0%) at a median of 5.6 years (25th–75th percentile, 3.1–9.8 years). Annual HCC incidence was 0.43% (95% confidence interval [CI], 0.22%–0.73%) and 0.62% (95% CI, 0.50%–0.76%) among patients with cirrhosis aged <50 years and ≥50 years at HBsAg seroclearance, respectively. In patients without cirrhosis who cleared HBsAg before age 50, the annual HCC incidence was 0.03% (95% CI, 0.01%–0.06%), comparable to 0.03% in general population. Annual HCC incidence of male patients without cirrhosis aged <40 and 40 to 49 years at HBsAg was 0.02% (95% CI, 0.002%–0.08%) and 0.09% (95% CI, 0.03%–0.19%), respectively. No HCC cases occurred during 15 years/ of follow-up among 1317 female patients without cirrhosis aged <50 years at HBsAg loss; the annual HCC incidence was 0.06% (95% CI, 0.02%–0.13%) among those aged 50 to 59 years.
Conclusions: Patients with CHB who clear HBsAg at younger ages, particularly men <40 years and women <50 years without cirrhosis or additional risk factors, have very low HCC risk and may not require routine surveillance.
Gastroenterology , article en libre accès, 2026