Predictive Factors for Hepatocellular Carcinoma Occurrence or Recurrence after Direct-Acting Antiviral Agents in Patients with Chronic Hepatitis C
Yu Yoshimasu, Yoshihiro Furuichi, Yoshitaka Kasai, Hirohito Takeuchi, Katsutoshi Sugimoto, Ikuo Nakamura, Takao Itoi
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Background & Aims: Direct-acting antiviral agents (DAAs) and the risk of hepatocellular carcinoma (HCC) is controversially reported in the literature. The primary endpoints of this study were to clarify the cumulative incidence and recurrence rate of HCC after DAA treatment. The secondary endpoints were to identify the factors associated with the occurrence or recurrence of HCC after DAAs treatment.
Methods: Of 234 HCV patients, 211 with no history of HCC (no-HCC-history group) and 23 with previous treated HCC history (HCC-history group) were treated with DAAs and followed for more than 24 weeks to determine the incidence of HCC. Platelet count, albumin, α-fetoprotein (AFP) level, L3%, the FIB-4 index and APRI scores were analyzed as possible factors associated with HCC occurrence and recurrence. An intergroup comparison was made of the cumulative incidence of HCC. Cox proportional hazards regression was used to determine associations between blood test values and risk of HCC.
Results: The median observation period was 21 months. Cumulative incidence of HCC was higher in the HCChistory group than in the no-HCC-history group (p < 0.0001, 19.0 and 0.52 per 100 patient-years, respectively). Univariate analysis revealed platelet count, albumin, α-fetoprotein (AFP) level, AFP-L3%, and FIB-4 index and APRI scores at the end of DAA treatment as being significantly associated with occurrence/recurrence of HCC. Multivariate analysis revealed that AFP levels before and after the administration of DAAs and AFP-L3% after DAA were independently associated with the occurrence/recurrence of HCC (p = 0.045, 0.043, 0.005, respectively).
Conclusion: The HCC occurrence rate after DAA treatment was very low, and the recurrence rate lower than that in previous interferon reports. The AFP level and AFP-L3% were identified as important factors in predicting occurrence/recurrence of HCC. Careful observation is needed when increased levels of AFP or AFP-L3% after DAAs treatment are observed.
Key words: direct-acting antiviral agents – hepatocellular carcinoma – hepatitis C virus.
Abbreviations: AFP: α-fetoprotein; APRI: AST to Platelet Ratio Index; ASV: asunaprevir; CHC: chronic hepatitis C; CT: computer tomography; DAA: direct-acting antiviral agent; DSV: daclatasvir; FIB-4, fibrosis-4; HCC: hepatocellular carcinoma; HCV: hepatitis C virus; IFN: interferon; MRI: magnetic resonance imaging; SVR: sustained virological response; US: ultrasonography.