Hidenori Toyoda*, Takashi Kumada, Toshifumi Tada, Seiki Kiriyama, Makoto Tanikawa, Yasuhiro Hisanaga, Akira Kanamori, Shusuke Kitabatake and Takanori Ito
DOI: 10.1111/jgh.12915
Abstract
Background and Aim
Hepatocellular carcinoma (HCC) can develop in patients with chronic hepatitis C after they have achieved a sustained virologic response (SVR) to antiviral therapy, i.e., eradication of hepatitis C virus (HCV). Thus, surveillance for HCC remains necessary after SVR. We investigated factors that are predictive of HCC in HCV-infected patients who achieved SVR.
Methods
Methods
The incidence and risk factors for HCC were evaluated in 522 patients who achieved SVR with interferon-based antiviral therapy for HCV. Patients maintained regular follow-up every 6 months for HCC surveillance. The FIB-4 index and aspartate aminotransferase to platelet count ratio index calculated based on laboratory data at the time that SVR was documented (SVR24).
Results
Results
Patients continued follow-up visits for 1.0 to 22.9 years (median, 7.2 years) after SVR. HCC developed in 18 patients. The incidence of HCC was 1.2% at five years and 4.3% at ten years. Use of peginterferon or ribavirin for treatment and a history of antiviral therapy prior to the course when SVR was achieved were not associated with the incidence of HCC after SVR. Presence of diabetes mellitus (risk ratio 2.08; p=0.0451) and FIB-4 index calculated at the time of SVR24 (risk ratio 1.73; p=0.0198) were associated with a higher likelihood of HCC after SVR by multivariate analysis.
Conclusions
Conclusions
Patients with diabetes mellitus and patients with the elevation of FIB-4 index at SVR24 are at higher risk of HCC after SVR. Surveillance for HCC should be continued in this patient subpopulation.
Accepted manuscript online: 13 FEB 2015 04:58AM EST | DOI: 10.1111/jgh.12915
Accepted manuscript online: 13 FEB 2015 04:58AM EST | DOI: 10.1111/jgh.12915
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