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Risk factors for development of hepatocellular carcinoma in patients with chronic hepatitis C without sustained response to combination therapy.
J Formos Med Assoc. 2018 Nov; 117(11):1011-1018.JF

Abstract

BACKGROUND/PURPOSE

Although antiviral therapy reduces development of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (CHC), HCC often develops in patients with non-sustained virologic response (non-SVR). We aimed to evaluate risk factors for HCC in HCV patients with non-SVR.

METHODS

From March 2002 to December 2013, 800 patients with CHC who had received combined pegylated interferon (peg-IFN)/ribavirin (RBV) therapy without achieving SVR were enrolled. Main outcome measure was HCC development. Variables were cirrhosis, platelet count, α-fetoprotein (AFP) levels, aspartate aminotransferase (AST) to platelet ratio index (APRI), and IL28B polymorphism (CT + TT).

RESULTS

One-hundred of 800 non-SVR patients developed HCC within a median 53.5-months follow-up. Cumulative incidence of HCC for all patients was 1.4%, 5.6% and 12.3%, respectively, at 1st, 3rd and 5th years of follow-up. In univariate analysis, patients who developed HCC tended to have LC (p< 0.001), lower platelet counts (<150 × 109/l, p < 0.001), higher AFP levels (≥20 ng/ml, p < 0.001), higher Fib-4 levels (p < 0.001), higher APRI levels (p < 0.001), IL 28B polymorphism (CT + TT) (p < 0.001) and higher incidence of diabetes mellitus (DM) (p = 0.019). Multivariate analysis in overall patients revealed that cirrhosis (HR: 2.94, 95% CI: 1.81-4.77, p < 0.001), IL28B rs12979860 (CT + TT) polymorphisms (HR: 3.22, 95% CI: 2.17-4.78, p < 0.001), and high APRI levels (≥2.57) (HR: 2.32, 95% CI: 1.47-3.67, p < 0.001) were independent risk factors for HCC.

CONCLUSION

Liver cirrhosis, high APRI levels, and IL28B rs12979860 at baseline are independent risk factors for HCC development in patients without SVR after peg-IFN combination therapy.

Authors+Show Affiliations

Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC. Electronic address: ux2551207@yahoo.com.tw.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29254684

Citation

Chang, Kuo-Chin, et al. "Risk Factors for Development of Hepatocellular Carcinoma in Patients With Chronic Hepatitis C Without Sustained Response to Combination Therapy." Journal of the Formosan Medical Association = Taiwan Yi Zhi, vol. 117, no. 11, 2018, pp. 1011-1018.
Chang KC, Ye YH, Wu CK, et al. Risk factors for development of hepatocellular carcinoma in patients with chronic hepatitis C without sustained response to combination therapy. J Formos Med Assoc. 2018;117(11):1011-1018.
Chang, K. C., Ye, Y. H., Wu, C. K., Lin, M. T., Tsai, M. C., Tseng, P. L., & Hu, T. H. (2018). Risk factors for development of hepatocellular carcinoma in patients with chronic hepatitis C without sustained response to combination therapy. Journal of the Formosan Medical Association = Taiwan Yi Zhi, 117(11), 1011-1018. https://doi.org/10.1016/j.jfma.2017.11.008
Chang KC, et al. Risk Factors for Development of Hepatocellular Carcinoma in Patients With Chronic Hepatitis C Without Sustained Response to Combination Therapy. J Formos Med Assoc. 2018;117(11):1011-1018. PubMed PMID: 29254684.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for development of hepatocellular carcinoma in patients with chronic hepatitis C without sustained response to combination therapy. AU - Chang,Kuo-Chin, AU - Ye,Yi-Hao, AU - Wu,Cheng-Kun, AU - Lin,Ming-Tsung, AU - Tsai,Ming-Chao, AU - Tseng,Po-Lin, AU - Hu,Tsung-Hui, Y1 - 2017/12/15/ PY - 2017/05/22/received PY - 2017/11/08/revised PY - 2017/11/14/accepted PY - 2017/12/20/pubmed PY - 2019/1/4/medline PY - 2017/12/20/entrez KW - APRI KW - Fib-4 KW - Hepatitis C virus KW - Hepatocellular carcinoma KW - IL28B KW - Non-sustained virologic response SP - 1011 EP - 1018 JF - Journal of the Formosan Medical Association = Taiwan yi zhi JO - J. Formos. Med. Assoc. VL - 117 IS - 11 N2 - BACKGROUND/PURPOSE: Although antiviral therapy reduces development of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (CHC), HCC often develops in patients with non-sustained virologic response (non-SVR). We aimed to evaluate risk factors for HCC in HCV patients with non-SVR. METHODS: From March 2002 to December 2013, 800 patients with CHC who had received combined pegylated interferon (peg-IFN)/ribavirin (RBV) therapy without achieving SVR were enrolled. Main outcome measure was HCC development. Variables were cirrhosis, platelet count, α-fetoprotein (AFP) levels, aspartate aminotransferase (AST) to platelet ratio index (APRI), and IL28B polymorphism (CT + TT). RESULTS: One-hundred of 800 non-SVR patients developed HCC within a median 53.5-months follow-up. Cumulative incidence of HCC for all patients was 1.4%, 5.6% and 12.3%, respectively, at 1st, 3rd and 5th years of follow-up. In univariate analysis, patients who developed HCC tended to have LC (p< 0.001), lower platelet counts (<150 × 109/l, p < 0.001), higher AFP levels (≥20 ng/ml, p < 0.001), higher Fib-4 levels (p < 0.001), higher APRI levels (p < 0.001), IL 28B polymorphism (CT + TT) (p < 0.001) and higher incidence of diabetes mellitus (DM) (p = 0.019). Multivariate analysis in overall patients revealed that cirrhosis (HR: 2.94, 95% CI: 1.81-4.77, p < 0.001), IL28B rs12979860 (CT + TT) polymorphisms (HR: 3.22, 95% CI: 2.17-4.78, p < 0.001), and high APRI levels (≥2.57) (HR: 2.32, 95% CI: 1.47-3.67, p < 0.001) were independent risk factors for HCC. CONCLUSION: Liver cirrhosis, high APRI levels, and IL28B rs12979860 at baseline are independent risk factors for HCC development in patients without SVR after peg-IFN combination therapy. SN - 0929-6646 UR - https://www.unboundmedicine.com/medline/citation/29254684/Risk_factors_for_development_of_hepatocellular_carcinoma_in_patients_with_chronic_hepatitis_C_without_sustained_response_to_combination_therapy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0929-6646(17)30393-5 DB - PRIME DP - Unbound Medicine ER -