ArticleClinical and molecular hepatology2021
Negligible risks of hepatocellular carcinoma during biomarker-defined immune-tolerant phase for patients with chronic hepatitis B.
Article in Clinical and molecular hepatology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- KASL clinical practice guidelines for management of chronic hepatitis B.Clinical and molecular hepatology · 2022Guideline
- KASL clinical practice guidelines for management of chronic hepatitis B Endorsed by the East Asia Liver Alliance (EALA).Clinical and molecular hepatology · 2026Article
- Antiviral treatment response to nucleos(t)ide analogues in chronic hepatitis B patients with normal alanine aminotransferase levels: a retrospective multi-center study.Emerging microbes & infections · 2025Article
- Cumulative Hepatitis B Surface Antigen/Hepatitis B Virus DNA Ratio in Immune-tolerant Hepatitis B Patients: A 10-year Follow-up Study.Journal of clinical and translational hepatology · 2025Article
- Projected Mitigation of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B in the Gray Zone and the Immune-Tolerant Phase in the United States.Digestive diseases and sciences · 2025Article
- HBV-related HCC development in mice is STAT3 dependent and indicates an oncogenic effect of HBx.JHEP reports : innovation in hepatology · 2024Article
- Canadian Association for the Study of the Liver Single Topic Conference on Hepatitis B Virus: 'Progress toward hepatitis B elimination in Canada'.Canadian liver journal · 2024Article
- Gray zone of hepatitis B virus infection.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association · 2024Article
- HBeAg-positive grey-zone patients: Treatment beyond guideline recommendations?Clinical and molecular hepatology · 2023Article
- The imitator of immune-tolerant chronic hepatitis B: A killer in disguise.Clinical and molecular hepatology · 2023Article
- Long-term prognosis and the need for histologic assessment of chronic hepatitis B in the serological immune-tolerant phase.Clinical and molecular hepatology · 2023Article
- Is liver biopsy essential to identifying the immune tolerant phase of chronic hepatitis B?Clinical and molecular hepatology · 2023Article
- Letter regarding "Long-term prognosis and the need for histologic assessment of chronic hepatitis B in the serological immune-tolerant phase".Clinical and molecular hepatology · 2023Article
- Surveillance for hepatocellular carcinoma: It is time to move forward.Clinical and molecular hepatology · 2022Article
- Review
- A nomogram based on HBeAg, AST, and age to predict non-minimal liver inflammation in CHB patients with ALT <80 U/L.Frontiers in immunology · 2022Article
- [ALT threshold value should be lowered for initiating antiviral therapy in patients with chronic HBV infection].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2021Article
- Association of Physical Activity with the Risk of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B.Cancers · 2021Article
- Negligible risk of hepatocellular carcinoma in chronic hepatitis B patients in immune-tolerant phase: Myth or fact.Clinical and molecular hepatology · 2021Article
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9 authors at 2 institutions in 1 country.
Funding
Abstract
BACKGROUND/
aimsThe immune-tolerant (IT) phase of chronic hepatitis B (CHB) patients is not generally indicative of antiviral therapy (AVT). We assessed and compared the risk of hepatocellular carcinoma (HCC) during the IT-phase stringently defined by a low fibrosis-4 (FIB-4) index, compared to that in patients undergoing AVT.
methodsAmong 125 untreated patients that were hepatitis B e-antigen positive, hepatitis B virus-DNA >20,000 IU/mL, with normal alanine aminotransferase level from 2012 to 2018, those with a FIB-4 index of <1.45 were classified into the IT-group. The cumulative probability of HCC was estimated using Kaplan-Meier analysis. All patients were assessed until HCC development (intention-to-treat [ITT] analysis), whereas those suspected of experiencing CHB phase switch were assessed using the per-protocol (PP) and censored at the time of phase switch.
resultsThe cumulative probability of HCC at 1-, 3-, and 5-years among the IT-group was zero, compared to AVT-treated patients with FIB-4 indices <1.45 during the same period: 0.2%, 0.6%, and 1.4%, respectively (P=0.264 for ITT and P=0.533 for PP). Among the initially screened 125 untreated patients, those with a FIB-4 index of ≥1.45 had a higher risk of HCC compared to the IT-group (P=0.005). Furthermore, among AVT-treated patients, those with a FIB-4 index of ≥1.45 had a higher risk of HCC compared to their counterpart (P<0.001).
conclusionThe risk of HCC was negligible in the IT-group stringently defined by a low FIB-4 index. However, given that a higher HCC risk exists among untreated patients with higher FIB-4, appropriate criteria for AVT should be established.
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