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Predictive Factors for Hepatocellular Carcinoma in Chronic Hepatitis B Using Structural Equation Modeling: A Prospective Cohort Study

Laurent Lam 1, 2 Hélène Fontaine 3 Marc Bourliere 4 Clovis Lusivika-Nzinga 1 Céline Dorival 1 Dominique Thabut 5 Fabien Zoulim 6 François Habersetzer 7 Tarik Asselah 8 Jean-Charles Duclos-Vallee 9 Jean-Pierre Bronowicki 10 Philippe Mathurin 11 Thomas Decaens 12 Nathalie Ganne 13 Dominique Guyader 14, 15 Vincent Leroy 16 Isabelle Rosa 17 Victor De Ledinghen 18 Paul Cales 19 Xavier Causse 20 Dominique Larrey 21 Olivier Chazouilleres 2 Moana Gelu-Simeon 22, 23 Véronique Loustaud-Ratti 24 Sophie Métivier 25 Laurent Alric 25, 26 Ghassan Riachi 27 Jérôme Gournay 28 Anne Minello 29 Albert Tran 30, 31 Claire Geist 32 Armand Abergel 33 François Raffi 34 Louis D’alteroche 35 Isabelle Portal 36 Nathanaël Lapidus 1 Stanislas Pol 37 Fabrice Carrat 1, *
* Corresponding author
Abstract : BACKGROUND and AIMS: The factors predicting hepatocellular carcinoma (HCC) occurrence in chronic hepatitis B need to be precisely known to improve its detection. We identified pathways and individual predictive factors associated with HCC in the ANRS CO22 HEPATHER cohort. METHODS: The study analyzed HBV-infected patients recruited at 32 French expert hepatology centers from August 6, 2012, to December 31, 2015. We excluded patients with chronic HCV, HDV and a history of HCC, decompensated cirrhosis or liver transplantation. Structural equation models were developed to characterize the causal pathways leading to HCC occurrence. The association between clinical characteristics (age, gender, body-mass index, liver fibrosis, alcohol consumption, smoking status, diabetes, hypertension, dyslipidemia, alpha-fetoprotein, HBV DNA levels, antiviral therapy) and incident HCC was quantified. RESULTS: Among the 4,489 patients included, 33 patients reported incident HCC. The median follow-up was 45.2 months. Age (β = 0.18 by decade, 95% CI 0.14-0.23), male gender (β = 0.23, 95% CI 0.18-0.29), metabolic syndrome (β = 0.28, 95% CI 0.22-0.33), alcohol consumption (β = 0.09, 95% CI 0.05-0.14) and HBV DNA (β = 0.25, 95% CI 0.17-0.34) had a significant and direct effect on the occurrence of advanced liver fibrosis. Liver fibrosis (β = 0.71, 95% CI 0.55-0.87) predicted, in turn, the occurrence of HCC. CONCLUSIONS: Liver fibrosis mediates the effects of age, gender, alcohol, metabolic syndrome and HBV DNA on the occurrence of HCC. Elderly men with chronic hepatitis B, risky alcohol use, advanced liver fibrosis, metabolic syndrome and high HBV DNA levels should be monitored closely to detect the development of HCC.
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Submitted on : Tuesday, June 15, 2021 - 9:25:34 AM
Last modification on : Tuesday, July 13, 2021 - 3:28:17 AM

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Laurent Lam, Hélène Fontaine, Marc Bourliere, Clovis Lusivika-Nzinga, Céline Dorival, et al.. Predictive Factors for Hepatocellular Carcinoma in Chronic Hepatitis B Using Structural Equation Modeling: A Prospective Cohort Study. Clinics and Research in Hepatology and Gastroenterology, Elsevier, 2021, pp.101713. ⟨10.1016/j.clinre.2021.101713⟩. ⟨hal-03224103⟩

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