Hepatocellular carcinoma development after hepatitis B surface antigen seroclearance in chronic hepatitis B patients: a 10-year single-center cohort study.

BACKGROUND

Hepatitis B surface antigen (HBsAg) seroclearance is considered a functional cure in chronic hepatitis B (CHB), yet the risk of hepatocellular carcinoma (HCC) may persist. This study aimed to evaluate HCC incidence and identify risk factors after HBsAg seroclearance.

METHODS

This retrospective single-center cohort included 259 CHB patients who achieved HBsAg seroclearance between 2013 and 2023. Patients with pre-existing HCC were excluded. During follow-up, 22 patients developed HCC. Clinical, demographic, and laboratory variables were analyzed. Independent risk factors were determined using multivariate logistic regression.

RESULTS

HCC developed in 22 (8.49%) patients after seroclearance. In multivariate logistic analysis, a higher cirrhosis, age, male sex, platalet count, and hepatitis B score and shorter HBV infection duration were independently associated with HCC development after HBsAg seroclearance ( P  < 0.005). Male sex and older age were significant in univariate analysis but not in multivariate analysis. Markers of liver dysfunction and fibrosis were significantly worse in patients who developed HCC.

CONCLUSION

HBsAg seroclearance reduces but does not eliminate the risk of HCC. Patients with advanced liver disease and high-risk profiles remain vulnerable, underscoring the need for continued, risk-adapted HCC surveillance after seroclearance.