Dynamic α-fetoprotein, platelets and AST-to-platelet ratio index predict hepatocellular carcinoma in chronic hepatitis C patients with sustained virological response after antiviral therapy

Cheng Kun Wu, Kuo Chin Chang, Chao Hung Hung, Po Lin Tseng, Sheng Nan Lu, Chien Hung Chen, Jing Houng Wang, Chuan Mo Lee, Ming Chao Tsai, Ming Tsung Lin, Yi Hao Yen, Tsung Hui Hu*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

21 Scopus citations

Abstract

Background: Hepatitis Cvirus (HCV)-infected patientswho achieve viral eradicationmay still develop hepatocellular carcinoma (HCC). Little is known about the impact of dynamic change of serum markers on HCC development. Methods: We enrolled 1351 HCV-infected patients who achieved sustained virological response (SVR). Laboratory datawere collected at least 1 year after IFN-based therapy and to the latest follow-up. Data on α-fetoprotein (AFP) were obtained >6 months prior to HCC development to exclude HCC-related AFP elevation. Results: HCC developed in 49 patients. Risk factors for HCC in SVR patients were old age, liver cirrhosis, higher pre- and post-treatment AFP and high post-treatment AST-to-platelet ratio index (APRI). Patients with pre- AFP ≥15 ng/mL→post-AFP ≥15 ng/mL (at 1 year, 23.1%; 5 years, 42.3%) and pre-AFP <15 ng/mL→post-AFP ≥15 ng/mL (at 1 year, 25%; 5 years, 50%) had the highest risk of HCC development, followed by pre- AFP ≥15 ng/mL→post-AFP<15 ng/mL (at 1 year, 5.2%; 5 years, 7.6%) and pre-AFP<15 ng/mL→post-AFP ng/mL <15 ng/mL (at 1 year, 0.5%; 5 years, 0.9%) (P<0.001). The pattern was similar for platelets and APRI (P<0.001). SVR patients with pre-APRI ≥0.7→post-APRI ≥0.7 had the highest risk of HCC development, followed by comparable risks among the other three groups. Conclusions: SVR patients with a persistently high AFP level (≥15 ng/mL) and a high APRI (≥0.7) before and after treatment had the highest incidence of HCC development. Patients with a reduction of AFP and APRI to the normal range after treatment had a markedly decreased risk of HCC. The risk was lowest for patients who kept persistently normal AFP and APRI before and after treatment.

Original languageEnglish
Pages (from-to)1943-1947
Number of pages5
JournalJournal of Antimicrobial Chemotherapy
Volume71
Issue number7
DOIs
StatePublished - 07 2016

Bibliographical note

Publisher Copyright:
© The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

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