1. Impact of metabolic risk factors on HCC
소화기내과 목요세미나
Impact of metabolic risk factors on HCC
in patients with chronic HBV infection
이 윤 빈

2. Improvement of Survival and Quality of Life
Goals of chronic hepatitis B treatment
Early and sustained suppression of HBV replication
Potent antiviral drugs with high barriers to resistance
Treatment-naïve patients vs. patients with drug-resistance
Patients with comorbidities
Possible side effects of antiviral drugs during long-term antiviral treatment
Prevention of disease progression to cirrhosis
Long-term antiviral treatment for indicated patients
Alcohol abstinence
Prevention of HCC development
Management of other modifiable risk factors
Improvement of Survival and Quality of Life

3. Risk factors of HCC in CHB patients
Demographic factors
Age
Male gender
Ethnicity: African origin
Family history of HCC
Virologic factors
High viral loads
HBV genotype: C > B
Hepatic fibrosis, cirrhosis
Excessive alcohol consumption
Active smoking
Diabetes or metabolic syndrome
EASL 2017 Clinical Practice Guidelines

4. Risk factors of HCC in CHB patients
Demographic factors
Age
Male gender
Ethnicity: African origin
Family history of HCC
Virologic factors
High viral loads
HBV genotype: C > B
Hepatic fibrosis, cirrhosis
Excessive alcohol consumption
Active smoking
Diabetes or metabolic syndrome
Long-term
antiviral
treatment
EASL 2017 Clinical Practice Guidelines

5. Yu MW et al. Gastroenterology 2017;153:1006-1017
Chan AW et al. J Gastroenterol Hepatol 2017;32:

6. HCV-infected patients vs. Non-infected controls
Metabolic risk factors and chronic hepatitis C
The relationship between chronic hepatitis C and type 2 diabetes
Increased risk of type 2 diabetes in patients with HCV infection
HCV-infected patients vs. Non-infected controls
White DL et al. J Hepatol. 2008;49:831-44

7. HCV-infected patients vs. HBV-infected patients
Metabolic risk factors and chronic hepatitis C
The relationship between chronic hepatitis C and type 2 diabetes
Excessive risk of diabetes in comparison to HBV-infected patients
HCV-infected patients vs. HBV-infected patients
White DL et al. J Hepatol. 2008;49:831-44

8. Metabolic risk factors and chronic hepatitis C
Extrahepatic manifestation of chronic hepatitis C
Improvement of cardiovascular outcomes after antiviral treatment
Hsu YC et al. Gut 2015;64:

9. Metabolic risk factors and chronic hepatitis B
Yu MW et al. Gastroenterology 2017;153:

10. Annual prevalence of steatosis in HBV-infected patients
Nonalcoholic fatty liver and chronic hepatitis B
NAFLD as hepatic manifestation of metabolic syndrome
Concurrent fatty liver was histologically diagnosed in 39.6% of the HBV-infected patients
The prevalence of histologically proven fatty liver in HBV-infected patients had gradually increased from 8.2% to 31.8% over 10 years
Annual prevalence of steatosis in HBV-infected patients
Prevalence
Chan AW et al. J Gastroenterol Hepatol 2017;32:
Wang MM et al. Dig Dis Sci 2014; 59:2571-9

11. Nonalcoholic fatty liver and chronic hepatitis B
HBV infection is a potential trigger of hepatic steatosis
HBV infection
Liver steatosis
Shi YX et al. World J Gastroenterol 2016;22:8161-7

12. ※ HOMA-IR = fasting insulin (μU/mL) × plasma glucose (mmol/L)/22.5
Metabolic risk factors and HCC risk
Insulin resistance and the risk of hepatic fibrosis and HCC in CHC
Insulin resistance and diabetes increase hepatic fibrosis in patients with genotype 1 HCV infection
Insulin resistance is associated with HCC in patients with HCV infection
P <
※ HOMA-IR = fasting insulin (μU/mL) × plasma glucose (mmol/L)/22.5
Petta S et al. Am J Gastroenterol 2008;103:
Hung CH et al. World J Gastroenterol 10;16:

13. (95% confidence interval)
Nonalcoholic fatty liver and HCC risk
Concurrent histologically proven fatty liver is an independent risk factor potentiating HBV-associated HCC development
Adjusted hazard ratio
(95% confidence interval)
7.272 (1.521–34.76)
P = 0.013
Chan AW et al. J Gastroenterol Hepatol 2017;32:

14. Nonalcoholic fatty liver and HCC risk
Lee YB et al. Under Review

15. Nonalcoholic fatty liver and HCC risk
Before IPW
After IPW
aHR (95% CI)
Steatosis ≥5% vs. <5% 3.01 (1.12–8.05)
aHR (95% CI)
Steatosis ≥5% vs. <5% 1.71 (0.40–7.23)
Lee YB et al. Under Review

16. Nonalcoholic fatty liver and HCC risk
Cho H et al. Under Review

17. Nonalcoholic fatty liver and HCC risk
Before IPW
After IPW
aHR (95% CI)
Fatty liver (yes vs. no) 1.67 (1.05–2.63)
aHR (95% CI)
Fatty liver (yes vs. no) 1.61 (1.06–2.47)
Cho H et al. Under Review

18. Metabolic risk factors and liver-related mortality
Adjusted hazard ratio (95% confidence interval)
No. of metabolic risk factors ≥3 vs (1.32–5.59)
≥3 metabolic risk factors vs. non-obese, non-diabetic 2.96 (1.45–6.04)
Yu MW et al. Gastroenterology 2017;153:

19. Metabolic risk factors and mortality in CHB patients
Lee YB et al. In Preparation

20. Metabolic risk factors and mortality in CHB patients
Lee YB et al. In Preparation

21. Criteria for Diagnosis of
Metabolic risk factors and mortality in CHB patients
Death, n (%)
2,951
(9.73)
Death from unknown cause 28
(0.96)
Death from known cause
2,923
(99.05)
Liver-related mortality
1,304
(44.19)
Non-liver-related mortality
1,619
(54.86)
Extrahepatic cancer-related mortality
689
(23.35)
Cardiovascular mortality
247
(8.37)
Criteria for Diagnosis of
Metabolic Syndrome
Lee YB et al. In Preparation

22. 경청해주셔서 감사합니다!