Incidence and predictors of hepatocellular carcinoma in Caucasian chronic hepatitis B patients receiving entecavir or tenofovir

George V. Papatheodoridis, George N. Dalekos, Cihan Yurdaydin, Maria Buti, John Goulis, Pauline Arends, Vana Sypsa, Spilios Manolakopoulos, Giampaolo Mangia, Nikolaos Gatselis, Onur Keskin, Savvoula Savvidou, Bettina E. Hansen, Christos Papaioannou, Kostantinos Galanis, Ramazan Idilman, Massimo Colombo, Rafael Esteban, Harry L A Janssen, Pietro Lampertico

Research output: Contribution to journalArticlepeer-review


Background & Aims: The risk of hepatocellular carcinoma (HCC) in Caucasian patients with chronic hepatitis B (CHB), treated with entecavir (ETV) or tenofovir (TDF), is unclear. We evaluated the incidence and predictors of HCC and the accuracy of existing HCC risk scores in Caucasian CHB patients receiving ETV/TDF. Methods: This large, multicentre, retrospective cohort study included 1666 adult Caucasian CHB patients under ETV/TDF for 39 months. CHB without cirrhosis, compensated and decompensated cirrhosis were present in 67%, 39%, and 3% of patients, respectively. The predictability of baseline parameters and three risk scores (GAG-HCC, CU-HCC, and REACH-B), developed in Asian patients, was assessed. Results: The cumulative probability of HCC was 1.3%, 3.4%, and 8.7% at year-1, year-3, and year-5 after ETV/TDF onset. Older age and lower platelets were strong independent HCC predictors in the total population and in the subgroups of cirrhotic and noncirrhotic patients, while liver disease severity was an independent HCC predictor in the total population and in the cirrhotics. GAG-HCC, CU-HCC, and REACH-B risk scores were associated with HCC development only in the univariable but not in the multivariable analyses and offered poor to modest predictability. Conclusions: HCC can still develop in Caucasian CHB patients treated with ETV/TDF. Besides the well-known predictors of HCC, such as older age, male gender and more advanced liver disease, lower platelets represent an independent factor of higher HCC risk. The applicability and predictability of HCC risk scores developed in Asian patients are poor or modest in Caucasian CHB patients, for whom different risk scores are required.

Original languageEnglish
Pages (from-to)363-370
Number of pages8
JournalJournal of Hepatology
Issue number2
Publication statusPublished - 2015


  • Cirrhosis
  • CU-HCC
  • Entecavir
  • Hepatitis B
  • Hepatocellular carcinoma
  • Risk scores
  • Tenofovir

ASJC Scopus subject areas

  • Hepatology
  • Medicine(all)


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