Yang DH, Wang WP, Zhang Q, Pan HY, Huang YC, Zhang JJ. Hepatocellular carcinoma progression in hepatitis B virus-related cirrhosis patients receiving nucleoside (acid) analogs therapy: A retrospective cross-sectional study. World J Gastroenterol 2021; 27(17): 2025-2038 [PMID: 34007137 DOI: 10.3748/wjg.v27.i17.2025]
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03537719
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May 04, 2021, 21:20
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Reader Comments:
We read with interest a retrospective cross-sectional study by Yang et al, who reviewed 266 patients with hepatitis B associated cirrhosis receiving Nucleos(t)ide analogs (NAs) antiviral therapy and found that age ≥60 years, smoking history, family history of HBV-associated hepatocellular carcinoma (HCC), fasting blood glucose (FBG)≥6.16mmol/L, lamivudine(LAM) resistance and HBV DNA negativity are independent risk factors for progression to HCC in HBV-associated cirrhosis during antiviral therapy for NA. Although antiviral therapy inhibited HBV DNA synthesis, there was no significant reduction in the incidence of HCC. Widespread use of NA antiviral therapy has been shown in the study to significantly reduce liver disease mortality, but this may increase life expectancy and the risk of HCC, leading to an increased burden of HCC in HBV epidemic population. As treatment approaches evolve, it is important to understand the risk factors for patients to progress to HCC, even if they have been cured of chronic HBV infection. This is especially important for patients with cirrhosis, who are thought to be most likely to develop HCC. Therefore, these findings of Yang et al have a very important positive effect on reducing the incidence of HCC. Study shows obesity is associated with liver damage and further accelerate the development of HCC. In Yang's study, there was no data on the number of patients with fatty liver disease or BMI. It is reasonable to propose whether obesity is an independent risk factor for HCC in NA-treated patients with chronic hepatitis (CHB) associated cirrhosis, and we believe this important issue should be further investigated.
Interestingly, Yang and his colleagues examined serum AFP levels in patients with progression to HCC. 65 patients with serum AFP<20μg/L had space occupation lesions and were diagnosed with HCC by MRI enhancement, histopathology, and liver DSA examination. Therefore, Yang et al suggest that serum AFP levels are of little value for early detection of HCC. AFP is the most used biomarker in HCC monitoring, but AFP is also elevated in some conditions, such as acute and chronic hepatitis, intrahepatic cholangiocarcinoma, and gonadal embryoma. So, its specificity is weakened, and AFP is not considered an ideal diagnostic biomarker for HCC.
Although Yang et al have proved that AFP cannot be used for early monitoring of HCC in HBV-related cirrhosis patients receiving NA treatment, the problem of lacking biomarkers for monitoring HBV and early diagnosis of HCC still exists. Considerable efforts are currently devoted to identifying promising biomarkers for the diagnosis of HCC Research. Such as serum HBV RNA or hepatitis B core-related antigen (HBcrAg) for the monitoring of HBV activities, M2BPGi for predicting HCC occurrence in CHB patients with cirrhosis. However, the current data suggest that no single biomarker is likely to have the best sensitivity and specificity. In other words, extended explorations are needed in terms of early detection.
It has been reported that with prolonged NA Treatment (Median Period 126 months), cccDNA can be significantly reduced. So, the value of Yang's study would be higher if the observations lasted longer. Besides, attention should be paid to the problem of drug resistance of NA. During the treatment of NA, drug resistance of patients needs to be detected in time, and additional or appropriate nucleoside (acid) analogs should be considered for continuous viral suppression.
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Reader's ID:
02861175
Submitted on:
May 04, 2021, 01:48
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Reader Comments:
The study is a well-designed, retrospective cross-sectional study with the outcome study were dependent and or independent variables that had a contributing on HCC progression on HBV-cirrhotic during AN-therapy. The AFP level may not be used as a marker of malignancy progression, but only for screening progression of the disease. this study results mentioning on Serum AFP has limited ability to diagnose HBV-related HCC.
Reader's ID:
00159305
Submitted on:
May 02, 2021, 13:06
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2 Abstract
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4 Background
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5 Methods
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6 Results
Are the research objectives achieved by the experiments used in this study?
Has the study made meaningful contributions towards research progress in this field?
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Reader Comments:
The paper is concise, well-written, without spelling or grammar errors. The scientific value of this article would have been even greater with a prospective study.
Reply from the Editorial Office:
Thank you very much for your comments.