Gastroenterology · 2026
Long-Term Incidence of Hepatocellular Carcinoma After Hepatitis B Surface Antigen Seroclearance.
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El-Debeiky Soleiman, Lam Tony Hiu-Fung, Lai Mandy Sze-Man, Tse Yee-Kit, Hui Vicki Wing-Ki, Lai Jimmy Che-To, Chan Henry Lik-Yuen, Wong Vincent Wai-Sun, Wong Grace Lai-Hung, Yip Terry Cheuk-Fung
Аннотация
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.
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.