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Predictors of hepatocellular carcinoma occurrence after direct‐acting antiviral therapy in patients with hepatitis C virus infection
Author(s) -
Watanabe Takao,
Tokumoto Yoshio,
Joko Kouji,
Michitaka Kojiro,
Horiike Norio,
Tanaka Yoshinori,
Tada Fujimasa,
Kisaka Yoshiyasu,
Nakanishi Seiji,
Yamauchi Kazuhiko,
Yukimoto Atsushi,
Hirooka Masashi,
Abe Masanori,
Hiasa Yoichi
Publication year - 2019
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.13278
Subject(s) - daclatasvir , medicine , sofosbuvir , hepatocellular carcinoma , ledipasvir , gastroenterology , hazard ratio , ribavirin , incidence (geometry) , hepatitis c virus , cumulative incidence , hepatitis c , simeprevir , antiviral therapy , confidence interval , oncology , chronic hepatitis , virus , transplantation , immunology , physics , optics
Aim The predictors for the development of hepatocellular carcinoma (HCC) after direct‐acting antiviral (DAA) treatment were investigated. Methods A total of 1174 patients with chronic hepatitis C virus infection were treated with DAA therapy (sofosbuvir and ledipasvir [ n = 615], sofosbuvir and ribavirin [ n = 380], and daclatasvir and asunaprevir [ n = 179]) and achieved sustained virologic response (SVR). The HCC development rate and the factors that might contribute to the development of HCC after the end of DAA treatment were analyzed. Results During the median observation period of 537 days, HCC developed in 33 cases. The incidence of HCC was 1.9%, 3.2%, and 4.1% at 1, 1.5, and 2 years after the end of DAA therapy, respectively. Multivariate analysis with pre‐ and post‐treatment factors identified the Fibrosis‐4 (FIB‐4) index (hazard ratio [HR] = 1.09; 95% confidence interval [CI], 1.021–1.178; P = 0.011) and post‐treatment α‐fetoprotein (AFP) (HR = 1.11; 95% CI, 1.054–1.172; P < 0.001) as independent factors that contributed to the development of HCC after DAA therapy. Using these identified parameters, a new scoring system (0 to 2 points) was established. Patients in the high‐score group (2 points) could be identified as having a significantly higher risk of HCC development, and the respective 1‐ and 2‐year cumulative incidence rates of HCC were 6.1% and 14.4%. Conclusions A high FIB‐4 index and a high post‐treatment AFP at the end of DAA treatment were the independent predictors for developing HCC after DAA treatment. For patients with these risk factors, extra attention to the possibility of HCC development is needed.