[Exploring the reasons for liver cancer occurrence still after long-term nucleos(t)ide analogue therapy in patients with chronic hepatitis B].

Chronic hepatitis B virus (HBV) infection is the main etiology of viral hepatitis, cirrhosis, and primary hepatocellular carcinoma and is also a major public health problem worldwide. With the progression of chronic infection, HBV DNA continuously integrates into host DNA and brings about integration and insertion mutations within host genes. In the process of repeated chronic inflammatory necrosis and compensatory regeneration, hepatocytes carrying HBV DNA integration have an advantage in proliferation and frequent clonal expansion formation that causes the accumulation of mutations over time and ultimately malignant transformation of hepatocytes. Although nucleos(t)ide analogs (NAs), currently the most widely used, can effectively inhibit viral replication, delay disease progression in patients with chronic hepatitis B, and significantly reduce the occurrence of end-stage liver disease, many patients still progress to liver cancer. Furthermore, even among clinically cured patients with hepatitis B surface antigen clearance, NAs have not significantly reduced the long-term occurrence of liver cancer, suggesting that their impact under previous treatment strategies for reducing the risk of liver cancer is limited. This could be due to antiviral treatment initiation at a time when patients already have numerous integrated cell proliferation colonies. Hence, NAs have not had any therapeutic impact on the expression of integrated HBV DNA fragments and viral proteins, such as hepatitis B surface antigen. In light of this, we suggest initiating antiviral treatment as early as possible to pursue clinical cure and ultimately reduce the risk of liver cancer in patients with chronic HBV infection.