Accurate Prediction of Liver Cancer Risk in Patients with Hepatitis B

Hepatitis B is not only a common viral infection in Taiwan; it is also a major public health issue worldwide. Patients with chronic hepatitis B suffer a high risk of developing liver cancer. At present, there is no permanent cure for chronic hepatitis B besides prevention by vaccination. Therefore, researchers have worked hard to find biological indicators that can accurately predict patients’ risk of liver cancer so as to implement early intervention and reduce complications. Moreover, patients unlikely to develop liver cancer are identified to avoid overtreatment and frequent follow-ups, thereby saving medical expenses and achieving the goal of personalized medicine.

Under the leadership of experienced researchers, the NTU College of Medicine and the NTU Hospital’s liver disease research team have been committed to conducting basic and clinical research on hepatitis and liver cancer. Previous research findings indicate that viral loads are an important indicator for predicting the risk of liver cancer. For patients with a high viral load, namely over 20,000 viral copies per millimeter of blood plasma, antiviral treatment will be prescribed to reduce the risk of liver cancer. Patients with a viral load of 2,000-20,000 copies/mL are categorized as medium-risk patients. As their risk of developing liver cancer is only slightly higher than that of patients with a viral load of lower than 2,000 copies/mL, controversies exist in the international treatment guidelines concerning whether antiviral treatment is necessary. To solve this problem, the research team applied a novel hepatitis B virus protein quantitative indicator, namely Hepatitis B core-related antigen (HBcrAg), to optimize the current prediction model.

The team followed up a total of 2,666 patients with chronic hepatitis B at the NTU Hospital for over 15 years. At the time of inclusion, the team performed antigen tests on the patients’ plasma samples and conducted viral load analysis. It was determined that a positive correlation exists between HBcrAg levels and liver cancer incidence. Patients with a HBcrAg level of higher than 10,000 KU/mL face significantly higher risks of developing liver cancer in the future than those whose HBcrAg level is lower than 10,000 KU/mL (Figure 1).

Published in prestigious medical journal Gastroenterology in December 2019, this paper was the first study in the world to demonstrate that HBcrAg levels can be analyzed in conjunction with viral load levels to more accurately predict the risk of liver cancer. If confirmed by other empirical studies, HBcrAg levels will become an important clinical indicator for assessing patients’ viral activity and liver cancer risk, enabling clinicians to improve personalized medicine.

This article is also featured in No. 76 of NTU Highlights (February, 2020).