On‐treatment gamma‐glutamyl transferase predicts the development of hepatocellular carcinoma in chronic hepatitis B patients

Background & Aims Gamma‐glutamyl transferase (GGT) has been predictive of chronic hepatitis C‐related hepatocellular carcinoma (HCC) development. Its role in the risk of HCC in chronic hepatitis B (CHB) patients treated with nucleotide/nucleoside analogues (NAs) is elusive. Methods A total of 2172 CHB patients from East Asia were randomized into development and validation groups in a 1:2 ratio. Serum GGT levels before and 6 months (M6) after initiating NAs and the potential risk factors were measured. The primary endpoint was HCC development 12 months after NA initiation. Results The annual incidence of HCC was 1.4/100 person‐years in a follow‐up period of 11 370.7 person‐years. The strongest factor associated with HCC development was high M6‐GGT levels (>25 U/L; hazard ratio [HR]/95% confidence interval [CI]: 3.31/2.02‐5.42, P