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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.
J Antimicrob Chemother. 2016 07; 71(7):1943-7.JA

Abstract

BACKGROUND

Hepatitis C virus (HCV)-infected patients who achieve viral eradication may 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 data were 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.

Authors+Show Affiliations

Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan dr.hu@msa.hinet.net.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27073265

Citation

Wu, Cheng-Kun, et al. "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." The Journal of Antimicrobial Chemotherapy, vol. 71, no. 7, 2016, pp. 1943-7.
Wu CK, Chang KC, Hung CH, et al. 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. J Antimicrob Chemother. 2016;71(7):1943-7.
Wu, C. K., Chang, K. C., Hung, C. H., Tseng, P. L., Lu, S. N., Chen, C. H., Wang, J. H., Lee, C. M., Tsai, M. C., Lin, M. T., Yen, Y. H., & Hu, T. H. (2016). 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. The Journal of Antimicrobial Chemotherapy, 71(7), 1943-7. https://doi.org/10.1093/jac/dkw097
Wu CK, et al. 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. J Antimicrob Chemother. 2016;71(7):1943-7. PubMed PMID: 27073265.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Wu,Cheng-Kun, AU - Chang,Kuo-Chin, AU - Hung,Chao-Hung, AU - Tseng,Po-Lin, AU - Lu,Sheng-Nan, AU - Chen,Chien-Hung, AU - Wang,Jing-Houng, AU - Lee,Chuan-Mo, AU - Tsai,Ming-Chao, AU - Lin,Ming-Tsung, AU - Yen,Yi-Hao, AU - Hu,Tsung-Hui, Y1 - 2016/04/12/ PY - 2015/10/15/received PY - 2016/02/29/accepted PY - 2016/4/14/entrez PY - 2016/4/14/pubmed PY - 2017/8/23/medline SP - 1943 EP - 7 JF - The Journal of antimicrobial chemotherapy JO - J. Antimicrob. Chemother. VL - 71 IS - 7 N2 - BACKGROUND: Hepatitis C virus (HCV)-infected patients who achieve viral eradication may 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 data were 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. SN - 1460-2091 UR - https://www.unboundmedicine.com/medline/citation/27073265/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_ L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkw097 DB - PRIME DP - Unbound Medicine ER -