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Post‐treatment levels of α‐fetoprotein predict long‐term hepatocellular carcinoma development after sustained virological response in patients with hepatitis C
Author(s) -
Tada Toshifumi,
Kumada Takashi,
Toyoda Hidenori,
Kiriyama Seiki,
Tanikawa Makoto,
Hisanaga Yasuhiro,
Kanamori Akira,
Kitabatake Shusuke,
Yama Tsuyoki,
Tanaka Junko
Publication year - 2017
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12839
Subject(s) - hepatocellular carcinoma , medicine , incidence (geometry) , receiver operating characteristic , proportional hazards model , hazard ratio , gastroenterology , cumulative incidence , cirrhosis , chronic hepatitis , oncology , immunology , virus , confidence interval , cohort , physics , optics
Aim The rate of hepatocellular carcinoma (HCC) development is reportedly lower in patients with chronic hepatitis C virus (HCV) who have achieved a sustained virological response (SVR) than in patients who were unresponsive to therapy. However, the development of HCC is sometimes observed in patients with SVR. Therefore, we clarified the predictive power of clinical factors for HCC incidence in patients with SVR using receiver operating characteristic (ROC) curve analysis that takes time dependence into account. Methods A total of 571 patients with HCV who achieved SVR with interferon‐based therapy were enrolled. Univariate and multivariate Cox proportional hazards models and time‐dependent ROC curves were used to analyze clinical factors associated with the development of HCC. Results Twenty‐four patients developed HCC during the follow‐up period (median duration, 9.0 years). The 5‐, 10‐, 15‐, and 20‐year cumulative incidence rates for HCC were 1.7%, 4.8%, 5.8%, and 6.6%, respectively. Multivariate Cox proportional hazards models showed that older age (hazard ratio [HR], 3.648), male sex (HR, 7.560), lower platelet count at 24 weeks after the end of treatment (SVR24) (HR, 3.939), and higher α‐fetoprotein (AFP) at SVR24 (HR, 3.630) were independently associated with HCC development. In addition, time‐dependent ROC analysis showed that, compared to platelet count at SVR24, AFP at SVR24 had higher predictive power for HCC incidence approximately 7 years after SVR. Conclusions Elevated AFP at SVR24 is a risk factor for HCC in patients with HCV, even those who achieve SVR. α‐Fetoprotein is a good predictor of HCC development.