TY - JOUR
T1 - Lack of reduction in serum alpha-fetoprotein during treatment with direct antiviral agents predicts hepatocellular carcinoma development in a large cohort of patients with hepatitis C virus-related cirrhosis
AU - Masetti, Chiara
AU - Lionetti, Raffaella
AU - Lupo, Marinella
AU - Siciliano, Massimo
AU - Giannelli, Valerio
AU - Ponziani, Francesca Romana
AU - Teti, Elisabetta
AU - Dell'Unto, Chiara
AU - Francioso, Simona
AU - Brega, Arianna
AU - Montalbano, Marzia
AU - Visco-Comandini, Ubaldo
AU - Taibi, Chiara
AU - Galati, Giovanni
AU - Vespasiani Gentilucci, Umberto
AU - Picardi, Antonio
AU - Andreoni, Massimo
AU - Pompili, Maurizio
AU - Pellicelli, Adriano M.
AU - D'Offizi, Gianpiero
AU - Gasbarrini, Antonio
AU - De Santis, Adriano
AU - Angelico, Mario
PY - 2018
Y1 - 2018
N2 - Risk of hepatocellular carcinoma (HCC) in hepatitis C virus cirrhotic patients treated with direct-acting antiviral agents (DAA) is still debating. We investigated it in a large cohort. The cohort comprised 1045 cirrhotic patients who completed treatment with DAA, with a median follow-up of 17.3 months after end of treatment (EOT), including 943 patients without history of HCC and 102 previously treated for HCC. The majority were men (59.9%), with compensated cirrhosis (88.8%), genotype 1b (44.7%). Univariate, multivariate analysis and Kaplan-Meier curves were performed to detect predictors of HCC in patients with and without reduction in alpha-fetoprotein (AFP) during treatment. SVR12 was 95.6%. HCC developed in 95 (9.9%), including 54 of 943 (5.7%) occurrent and 41 of 102 (39%) recurrent tumours. De novo were more often unifocal (P = 0.01) and curable (P = 0.03). AFP decreased from 16.1 ± 36.2 mg/dL (baseline) to 11.4 ± 55 mg/dL (EOT). At univariate analysis, predictors were a previous HCC, older age, higher model for end-stage liver disease, prolonged INR, lower platelets, baseline and EOT AFP, virological failure and no reduction in AFP during treatment. Kaplan-Meier curves showed lower incidence of HCC in patients showing any reduction in AFP (P = 0.001). Those with AFP <6 ng/mL had the lowest risk (P = 0.0002). At logistic regression, platelets (P = 0.009, OR 0.99 CI: 0.99-1.00), previous HCC (P < 0.000 01, OR: 10.76, 95% CI: 5.89-19.34) and no reduction in AFP during treatment (P = 0.0005, OR: 2.98, CI: 1.60-5.54) were independent predictors of HCC. In conclusion, risk of HCC after DAA treatment remains substantial. It is higher among patients with previous HCC, low platelets and without reduction in AFP during treatment.
AB - Risk of hepatocellular carcinoma (HCC) in hepatitis C virus cirrhotic patients treated with direct-acting antiviral agents (DAA) is still debating. We investigated it in a large cohort. The cohort comprised 1045 cirrhotic patients who completed treatment with DAA, with a median follow-up of 17.3 months after end of treatment (EOT), including 943 patients without history of HCC and 102 previously treated for HCC. The majority were men (59.9%), with compensated cirrhosis (88.8%), genotype 1b (44.7%). Univariate, multivariate analysis and Kaplan-Meier curves were performed to detect predictors of HCC in patients with and without reduction in alpha-fetoprotein (AFP) during treatment. SVR12 was 95.6%. HCC developed in 95 (9.9%), including 54 of 943 (5.7%) occurrent and 41 of 102 (39%) recurrent tumours. De novo were more often unifocal (P = 0.01) and curable (P = 0.03). AFP decreased from 16.1 ± 36.2 mg/dL (baseline) to 11.4 ± 55 mg/dL (EOT). At univariate analysis, predictors were a previous HCC, older age, higher model for end-stage liver disease, prolonged INR, lower platelets, baseline and EOT AFP, virological failure and no reduction in AFP during treatment. Kaplan-Meier curves showed lower incidence of HCC in patients showing any reduction in AFP (P = 0.001). Those with AFP <6 ng/mL had the lowest risk (P = 0.0002). At logistic regression, platelets (P = 0.009, OR 0.99 CI: 0.99-1.00), previous HCC (P < 0.000 01, OR: 10.76, 95% CI: 5.89-19.34) and no reduction in AFP during treatment (P = 0.0005, OR: 2.98, CI: 1.60-5.54) were independent predictors of HCC. In conclusion, risk of HCC after DAA treatment remains substantial. It is higher among patients with previous HCC, low platelets and without reduction in AFP during treatment.
KW - Hepatology
KW - Infectious Diseases
KW - Virology
KW - alpha-fetoprotein
KW - direct-acting antiviral agents
KW - hepatitis C
KW - hepatocellular carcinoma
KW - Hepatology
KW - Infectious Diseases
KW - Virology
KW - alpha-fetoprotein
KW - direct-acting antiviral agents
KW - hepatitis C
KW - hepatocellular carcinoma
UR - http://hdl.handle.net/10807/129450
UR - http://onlinelibrary.wiley.com/journal/10.1111/(issn)1365-2893
U2 - 10.1111/jvh.12982
DO - 10.1111/jvh.12982
M3 - Article
SN - 1352-0504
VL - 25
SP - 1493
EP - 1500
JO - Journal of Viral Hepatitis
JF - Journal of Viral Hepatitis
ER -