Prognosis and predictors of hepatocellular carcinoma in elderly patients infected with hepatitis B virus.
With rapidly aging population in the world, many elderly patients present with hepatitis B virus (HBV) infection. We conducted a retrospective cohort study involving 359 untreated HBV patients aged 60 and older who were free of hepatocellular carcinoma (HCC) and acute hepatitis at the initial visit, and examined the incidence of HCC and liver-related mortality rate. During the follow-up period of 7.9 years (range, 0-25 years), 26 patients (7.2% of patients) developed HCC, 20 patients died from liver-related diseases (61% of total deaths), including HCC, liver failure, and gastrointestinal bleeding. The cumulative rates of HCC at years 5, 10, and 15 were 6.5%, 15.6%, and 15.6%, respectively. The cumulative rates of mortality from liver-related diseases at years 5, 10, 15 were 3.3%, 12.3%, and 15.7%, respectively. Multivariate analysis identified HBV DNA (≥5.0 Log IU/mL), male gender, and FIB4-Index (≥3.6) as significant independent risk factors for HCC, and alpha-fetoprotein (≥10 ng/mL) as significant independent predictors of liver-related mortality. We conclude that high levels of HBV DNA, progression of liver fibrosis, and male gender are independent risk factors of HCC in untreated patients infected with HBV aged 60 and older.
['Osawa|Mitsutaka|M|0000-0001-6504-7799', 'Akuta|Norio|N|0000-0001-5386-9672', 'Suzuki|Fumitaka|F|', 'Fujiyama|Shunichiro|S|', 'Kawamura|Yusuke|Y|', 'Sezaki|Hitomi|H|', 'Hosaka|Tetsuya|T|', 'Kobayashi|Masahiro|M|', 'Kobayashi|Mariko|M|', 'Saitoh|Satoshi|S|', 'Arase|Yasuji|Y|', 'Suzuki|Yoshiyuki|Y|', 'Ikeda|Kenji|K|', 'Kumada|Hiromitsu|H|']
D000368:Aged D000369:Aged, 80 and over D006528:Carcinoma, Hepatocellular D015331:Cohort Studies D004279:DNA, Viral D005260:Female D005500:Follow-Up Studies D006515:Hepatitis B virus D019694:Hepatitis B, Chronic D006801:Humans D015994:Incidence D007564:Japan D008099:Liver D008103:Liver Cirrhosis D017093:Liver Failure D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D011379:Prognosis D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D000509:alpha-Fetoproteins
hepatocellular carcinoma elderly HBV mortality HBV DNA FIB4-index