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HBcrAg to Assess HCC Risk
HBcrAg: A Novel Serum Biomarker With Potential for HCC Risk Prediction

Released: May 06, 2021

Expiration: May 05, 2022

Yasuhito Tanaka
Yasuhito Tanaka, MD, PhD
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Chronic hepatitis B (CHB) affects approximately 260 million persons worldwide. A significant percentage (15% to 40%) of people with CHB develop cirrhosis and/or hepatocellular carcinoma (HCC), making it a health problem associated with a high risk of death.

Most new hepatitis B virus (HBV) infections occur in HBV-endemic regions, such as China, southeast Asia, and sub-Saharan Africa. Although the overall prevalence of CHB in Japan is relatively low (the hepatitis B surface antigen HBsAg prevalence was approximately 1.2 million in 2011), HCC was the fourth most frequent cause of cancer death in Japanese men and the sixth most common cause of cancer death in Japanese women in 2016. (There were 28,528 deaths from HCC reported in Japan in 2016.) But with the development of effective anti-HBV treatments and the availability of guidance on routine HCC surveillance from clinical societies in Japan, the United States, Europe, and the Asia-Pacific region, a decrease in HCC risk in patients with CHB is achievable.

In Japan, patients are considered to be at high risk for HCC if they have cirrhosis, CHB, or chronic hepatitis C and at extremely high risk if they have CHB and/or chronic hepatitis C plus the presence of cirrhosis. The Japan Society of Hepatology recommends that high-risk patients undergo surveillance with ultrasound and 1 or more serum biomarkers every 6 months (α-fetoprotein AFP, des-γ-carboxy-prothrombin DCP, AFP-lens culinaris agglutinin-binding fraction AFP-L3). Extremely high–risk patients should be screened with ultrasound and concomitant biomarkers every 3-4 months, with optional dynamic CT/MRI every 6-12 months. If small nodules are detected, dynamic CT/MRI or EOB-MRI should be applied as well as combined serum biomarkers (AFP, DCP, and AFP-L3).

In terms of HBV control, the current goal is to achieve virologic suppression, preferably with seroclearance of HBsAg, and concomitant histologic improvement and decreased risk of complications. However, some patients may develop HCC even after treatment with nucleos(t)ide analogues (NAs), and it is difficult to predict which patients will have progression of liver disease. Several HBV markers have been identified as factors correlated with the development of HCC in patients with CHB.

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