(INF-O3) The incidence of hepatocellular carcinoma in hepatitis B virus infected persons of different origins, living in Sweden


Ann-Sofi Duberg Infektionskliniken Universitetssjukhuset Örebro Örebro 1
Charlotte Lybeck Infektionskliniken Universitetssjukhuset Örebro Örebro 1
Anna Fält Klinisk Epidemiologi och Biostatistik Örebro Universitet Örebro 2
Heiner Wedemeyer Dept. of Gastroenterology and Hepatology Hannover Medical School Hannover Germany 3
Scott Montgomery Klinisk Epidemiologi och Biostatistik Örebro Universitet Örebro 2
Soo Aleman Infektionskliniken Karolinska Universitetssjukhuset Stockholm 4


Background: Surveillance for hepatocellular carcinoma (HCC) is recommended for cirrhotic patients with chronic hepatitis B (CHB). For non-cirrhotic CHB patients, the estimated cut-off for HCC-surveillance has been an annual incidence rate (IR) of 0.2%. Based on Asian and African studies, surveillance has been recommended at younger ages in men originating from Asia and Africa. Our aim was to study the incidence of HCC by age and origin in persons with CHB living in Sweden.
Method: All people diagnosed with CHB in Sweden during 1990-2015, their country of birth, co-infections, antiviral therapy, liver cancer or death/emigration were identified, using the national HBV-surveillance register and other national registers. Observation time started at date of reported CHB diagnosis. The IR was calculated by age group and origin.
Results: There were 16,410 persons (47% women), their origins were: Western Europe 2,316; Eastern Europe 2,349; Middle East/North Africa 4,402; Sub-Saharan Africa 3,677; Asia 3,537 and other 129. People from Sub-Saharan Africa were youngest with the shortest mean time in Sweden, 11.6 years. In total there were 232 HCCs (82% in men); 23, 54 and 58 in people from Sub-Saharan Africa, Asia and Middle East/North Africa, respectively. The IR exceeded 0.2% for men from Asia from age-group ≥40-49 years (IR 0.63, 95% CI 0.39-1.00), and for men of all other origins from age-group ≥50-59 years. In women, HCC was rare but IR exceeded 0.2% among those aged ≥60 years from East Europe, Asia and Middle East/North Africa.
Conclusion: Only men of Asian origin exceeded the proposed cut-off for HCC-surveillance by ages 40-49 years. African men exceeded this cut-off from age-group 50-59 years. This study of people with CHB confirms the high risk of HCC in men of Asian origin but questions the benefit of surveillance at younger ages for men of African origin living in Sweden.